Archived: Studley Bethesda Home

Studley Bethesda Home is a residential care home providing personal care to 7 people aged 65 and over at the time of the inspection. The service can support up to 13 people in one adapted building.

People’s experience of using this service and what we found

During this inspection, we identified breaches in relation to safe care and treatment, person centred care, safeguarding and good governance. We also made a recommendation about the management of some medicines.

People were not protected from risk of abuse. Unexplained injuries were not consistently investigated. Some staff felt that the registered manager did not take concerns raised about unexplained injuries seriously.

Risk to people was not always assessed and managed in a way that kept people safe from harm. The safety of the environment was not always considered as people’s needs became more complex. Accidents and incidents were not investigated robustly and actions to reduce future risk to people were not always implemented.

People received their medicines as prescribed, however medicines were not always stored safely.

We were not assured that staffing levels were sufficient to meet people’s needs overnight. Recruitment checks for staff were completed appropriately.

Care practices did not always promote people’s choice and dignity. We observed that some aspects of care in the home followed a task led approach rather than a person-centred approach.

Peoples changing needs were not always considered when supporting them with social and spiritual activities.

The staff team at the home were divided, some staff spoke of a closed culture which impacted people’s safety and wellbeing.

The registered manager did not always manage quality assurance and their regulatory responsibilities appropriately. Quality assurance systems had not identified the concerns we found as part of this inspection.

The service worked collaboratively with other healthcare professionals to promote good health outcomes for people. The registered manager managed complaints and compliments appropriately.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Good (14 March 2018).

Why we inspected

We received concerns in relation to risk management and support for people living with dementia. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person centred care and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Studley Bethesda Home 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.

Studley Bethesda Home was last inspected in October 2015 and was rated as Good overall. This inspection was unannounced and took place on 18th January 2018 and we found that standards had been maintained.

A registered manager was not in place 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. An interim manager was in post and worked alongside the registered manager throughout December 2017, to complete a full handover. The interim manager will remain in post until a new registered manager is appointed.

People told us they felt safe. Staff knew, and understood their responsibilities for safeguarding people against potential risk, or harm and were able to tell us how they would report any concerns. Staff received individual support meetings and training to support them in their role and staffing levels were appropriate to meet people’s needs. Risk assessments were in place which identified specific risks for individuals and detailed the support required.

Medicines were administered, recorded, stored and disposed of safely. People were encouraged to self-administer their own medications and were supported by staff in a safe manner. Protocols were in place for PRN (as required) medications, instructing staff on how and when to administer them.

People had access to food and drink throughout the day and were encouraged to make their own hot and cold drinks using the resident’s kitchen. People had been consulted about their meal preferences and were offered choices. People were supported to follow specific diets necessary to maintain their health and well-being.

People were supported to make their own decisions and staff had a sound knowledge of the Mental Capacity Act (2005) and how to apply this to the support they provided. Care and support plans were personalised and reviewed regularly.

There were auditing processes in place to monitor the quality of the care and services delivered. People and relatives were encouraged to give their views and ideas for change. People and their relatives were complimentary about the staff and the care they received.

Providers are required, by law, to display their CQC rating to inform the public on how they are performing. The latest CQC rating was displayed in the service and these details were also on the provider's website.

All the people we spoke with told us they felt staff treated them with kindness, respect and dignity. Staff told us they got to know people and their families very well. Staff said they used this knowledge to engage with people in meaningful conversations and to support people with their care appropriately. All the staff we spoke with told us it was important to treat people as individuals. People told us they liked living at the home and had opportunities to engage with a range of activities both within the home and local community.

We looked to see how people were supported to access other services. Some people told us they choose to make their own health appointments independently and others told us they required more support from staff. We observed the provider fully supported people's individual needs to access health services. This included making phone calls on behalf of people, making charitable donations for transport to appointments and attending appointments with people.

We spoke to people and staff to see how safely medicines were managed in the home. Most people chose staff to support them with their medicines. During our visit we observed medicines being administered to people. We found the provider's processes for the dispensing, administration and recording of medicines needed improving. We saw medicines were stored safely and disposed of appropriately.

We spoke with the manager about recruitment when we visited. We looked at records which showed there were effective recruitment and selection processes in place.

We looked at how the quality of the service was maintained and audited. We saw care plans had been reviewed and individual risks assessed for people. We saw the provider had recorded information about accidents and incidents and evaluated these for potential service improvements. The provider had a range of other records to show the upkeep of the building and equipment had been maintained.