Bethune Court

Bethune Court is a residential care home providing personal care to up to 45 people. The service provides support to older people and some people with dementia. At the time of our inspection there were 40 people using the service. The home is a purpose-built care environment over four floors. All areas of the home were accessible by wide corridors with hand-rails and two lifts.

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

People were supported by staff who knew them well and understood their needs. Risks to people were identified and managed and staff understood their responsibilities for safeguarding people. One person told us, “The place is very well run. The staff are marvellous. They are all professional people, they know what they are doing.”

There were enough suitable staff to care for people’s needs. People and their relatives spoke highly of the staff. Their comments included, “I have no concerns regarding to the care they give.” “Staff are very attentive with those who have dementia, they seem to sit and talk with them.” “I cannot praise them highly enough.”

There were safe systems for administering medicines, and people told us they received the help they needed to manage their health conditions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us they were supported to make choices and to remain as independent as possible. One relative said, “The staff support people to make choices, and they ask instead of telling people what to do.”

Management systems were robust, supported learning and drove improvements. The registered manager demonstrated clear oversight of the service and was knowledgeable about quality issues and priorities for the service.

Staff described having the training and support they needed. They spoke highly of care provided at the home and of the registered manager. One staff member said, “I enjoy it here, it’s really rewarding.” Another staff member told us, “I love it here, I’m really enjoying the practical part of the job and just seeing people smile.”

People, their relatives and staff were consistent in their positive view of the home and the management of the service. A relative told us, “I would recommend this home to others, I visit every day and the staff are polite and welcoming. I am impressed with the place.”

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

Rating at last inspection The last rating for this service was good (published 20 January 2020)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staffing and management of risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethune Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were well supported by staff to maintain contact with their family and loved ones. People had been supported with video calls when visiting was not possible. The service facilitated in- person visits in a manner which minimised the risk of infection spread. A dedicated visiting room was well laid out with a screened area for relatives to undertake Lateral Flow Devices (LFD) tests before the visit commenced.

The providers contingency planning and effective infection control procedures had ensured that the outbreak was well managed.

The provider had sensitively considered people’s anxieties and emotional wellbeing following the outbreak of Covid 19. Staff had supported residents with memorials, shared stories and remembrance to give an opportunity for those to grieve and come together.

The registered manager had created three Infection Control Champions to ensure staff were upskilled in Infection Prevention Control (IPC) measures and to bring best practice to the home. Care staff who had undertaken IPC champion training completed weekly quality assurance checks and shared good practice with staff to ensure IPC procedures were being followed.

We found the following examples of good practice.

The registered manager had completed risk assessments with all staff to identify if anyone was at increased risk from COVID-19. Where it had been identified that staff were at increased risk, adjustments had been made to the way they worked to support them to work safely.

There was a designated bathroom at the entrance of the home for visitors to use to wash their hands on entry and exit and to put on and remove their face mask. Signage in this room was very clear.

Bethune Court is a residential care home providing personal care to 40 people aged 65 and over at the time of the inspection. The service can support up to 45 people.

People required a range of help and support to maintain their independence whilst receiving support for personal care, health needs and with dementia. The home is a purpose-built care environment over four floors. All areas of the home were accessible by wide corridors with hand rails and two lifts.

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

People were happy with the care they received. People told us that staff were caring and compassionate and treated them with kindness. One person said, “It's very nice here. People are friendly. The staff are so nice.”

People told us they felt safe living at the home. They received their medicines correctly and were supported by enough staff to maintain their safety. Peoples needs were met effectively and were supported by skilled staff. They told us they liked the food and drink and were given choices in how they wished to spend their time.

People were supported to manage their healthcare needs and staff ensured they received any additional specialist support to remain healthy and well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they liked the activities provided but that staff respected their choices on how they wished to spend their day. People living with dementia were supported by skilled staff who demonstrated good knowledge and skills in supporting those with the condition.

People spoke positively about the management of the service and how they created an open and welcoming service. The registered manager demonstrated an ethos of continuous improvement and had quality assurance systems in place to ensure that good quality care was provided.

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

Rating at last inspection

The last rating for this service was Good (6 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is a purpose built care environment over four floors. All areas of the home were accessible by wide corridors with hand rails and two lifts. This was an unannounced inspection which took place on 5 June 2017.

Bethune Court had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home supported by the provider.

Bethune Court was inspected in June 2016 although there was no breach of regulation we rated the service as Requires Improvement in Safe and Well-led as some changes were needed to ensure documentation was completed accurately and consistently and auditing identified shortfalls and covered all relevant areas.

At this inspection we found that improvements had been made. However, we have made recommendations about the management of reportable incidents and we have made a recommendation about records and documentation. We will follow up on these recommendations at the next inspection.

Staff demonstrated an understanding of how to protect people from abuse. We found inconsistencies in how incidents were reported to external professionals. Documentation relating to wounds when a person returned to Bethune Court from hospital were not sufficient to give a detailed report of the wound. The registered manager arranged further training for themselves and senior staff to ensure all falls, accidents and incidents were reported to external organisations correctly and documented correctly.

Quality assurance systems were in place. This included medicines, care documentation and environmental audits. Although actions had taken place in response to audit findings this information was not consistently updated on audits to show this. Environmental and individual risk assessments had been completed. The home had a designated maintenance employee who was available at the home. Systems were in place to ensure emergency procedures were in place. And equipment and services were well maintained and checked regularly.

Staff had an understanding of MCA and DoLS. People were involved in day to day decisions about their care and how they spent their time. Staff understood dementia and how to support people with patience and kindness. People were treated with dignity and respect and their independence was supported and encouraged. Staff took the time to sit and chat with people. Documentation was personalised and included specific information about people’s backgrounds, choices and preferences.

Medicines systems were in place and people received their medicines safely and consistently. This system was being further enhanced to provide staff with more detail regarding people’s preferences for how they like to take their medicines.

Care plans had been written for peoples identified care needs. Care plans and risk assessments were regularly reviewed and updated. People and relatives felt involved in this process. An activity schedule was in place. People told us they enjoyed the activities and spent their time how they chose.

Staff were aware of people’s preferences, for example, how they liked to dress and spend their time. People’s independence was encouraged and equality and diversity was supported.

People’s nutritional needs were monitored and reviewed. Kitchen staff were kept up to date with people’s nutritional needs. There was a choice of meals and alternatives available for people. People who needed assistance at meal times had this provided.

A complaints process was in place. When issues had been raised the actions taken had been documented. People had been consulted and felt involved in the changes made in response to their complaint.

People and staff spoke highly of the registered manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff felt they received appropriate training, supervision and support to enable them to provide good care. Staffing levels were reviewed and peoples dependency needs assessed to help the registered manager assess appropriate staffing levels. Recruitment systems were followed to ensure staff were suitable to work within the care sector staffing levels were reviewed to ensure people’s needs could be met.

The home is a purpose built care environment over four floors. All areas of the home were accessible by wide corridors with hand rails and two lifts.

This was an unannounced inspection which took place on 21 and 22 June 2016.

Bethune Court had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home supported by the provider. People and staff spoke highly of the registered manager and told us that they felt supported by them and knew that there was always someone available to support them when needed.

There were systems in place to assess and monitor the service provided. Although a number of these were effective some needed to be improved to ensure all areas of service provision were audited effectively. Some procedures and documentation needed to be improved to ensure clear consistent actions and reporting. This included accidents and incidents and some areas in relation to medicines. It was not possible to get a clear picture of how much people ate and drank. Information found in peoples care notes was contradictory and some charts had not been completed every day.

Staff provided care and support for people with kindness and patience. People’s dignity and privacy were respected and people were involved in decisions about how they received care and spent their time throughout the day.

Staff were able to tell us how they would report any suspected abuse, and people told us they felt safe living at Bethune Court. All staff and management had a good knowledge and understanding of Mental Capacity Assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). This meant that any decisions made had followed this process to ensure they were made in peoples best interest and supported by health professionals and Next of Kin (NoK)

Staff recruitment systems were in place and staffing levels were reviewed regularly to ensure people needs could be met. Staff received appropriate training and support to meet people’s needs with a focus on ensuring staff were trained and supported to provide good care for people with dementia and memory loss.

The home had a designated maintenance employee who was available at the home. Systems were in place to ensure emergency procedures were in place. And equipment and services were well maintained and checked regularly.

Feedback was gained from people and staff, this included questionnaires and regular meetings with minutes available for people to access. A complaints process was in place. When issues had been raised systems and processes had been reviewed to show learning from these and make improvements to prevent issues from re-occurring if possible.

An activity programme provided regular activities for people; this included a range of games, quizzes and visiting activity providers. To prevent social isolation people were encouraged to participate, for people who did not enjoy group activities activity staff visited them in their rooms.

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We also spoke with nine people who lived in the home, six members of staff, the manager and three relatives.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived in the home told us they felt safe and were well treated by staff. When asked if they ever witnessed anyone being badly treated, one person said 'Oh no that stuff doesn't take place in here', another person said in response to the same question 'No, the staff are all great in here '.We spoke with the manager and six members of staff on duty. They knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns. Staff and people we spoke with said they felt there was enough staff to meet the needs of people living at Bethune Court.

People were treated with dignity and respect by staff. Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. The home had a range of health and safety policies and procedures in place; we saw evidence of current risk assessments for fire safety, portable appliance testing premises and grounds.

The home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and we saw evidence of applications that had been made. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required by the law.

Staff recruitment practice was safe and thorough. During the inspection we observed a prospective member of staff undergo a Disclosure and Barring Service (DBS check). This meant only suitable people were employed with the right skills and experience.

Is the service effective?

People told us the manager and staff were effective in meeting their care and support needs .People were encouraged to be independent and were supported to achieve the best quality of life possible. People's care plans contained information about their support needs and personal preferences. People's needs were assessed before they moved to the home to ascertain whether the service could meet their requirements. People were involved in planning their care and any preferences or requirements.

Is the service caring?

People were supported by kind and attentive staff. We saw that carers showed patience and gave encouragement when supporting people. A relative we spoke with said 'The standard of care is very good, I have no concerns'. People were encouraged to be an independent as possible and we saw staff speak to people in a meaningful and respectful way. One person living in the home said 'They are very good about listening to what you want and they respect my independence'.

People's preferences, interests, likes, dislikes and different needs were written down in their support plans. This helped to make sure support was provided in accordance with people's wishes. We saw staff knock on people's doors and asked for permission before entering their rooms. All rooms had en suite facilities meaning the environment supported their privacy and dignity.

Is the service responsive?

People who lived in the home told us the manager and staff were always responsive to their needs and choices. People's care plans contained information about their support needs and personal preferences.

People completed a range of activities in and outside the service. The home had two activities coordinators who arranged monthly meetings with the people living there. The information from these meetings was used to develop and arrange a wide range of activities within the home.

The home had an effective complaints procedure. We looked at how complaints had been dealt with and found that responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The home is part of the Anchor Care group which is a large non-profit organisation. The business manager was registered with the Care Quality Commission as the registered manager of the service. Policies and procedures were centralised from head office and cascaded into the home. The company has its own intranet which served to inform senior staff of organisational changes, updates and policy changes. The home worked well with other agencies, such as social workers, G.P.'s and district nurses to make sure people received their care in a joined up way.

The service had a robust quality assurance system. The records we looked at showed that any shortfalls were addressed quickly. This helped to ensure that people received a good quality service at all times.

We saw that staff sought consent from people on day to day issues, and people gave their views on what they would like to wear, do and eat each day. Staff completed risk assessments for people in relation to falls, moving and handling and nutrition and people had individual care plans based on their risk assessments.

The manager wrote to us with an action plan which told us how these shortfalls would be addressed. This inspection was carried out to follow up on the progress made by the home in relation to this essential standard.

We found that action had been taken which had ensured the outstanding electrical maintenance works had been completed.

We looked at records that showed personal preferences had been recorded. People told us that their individual wishes were respected at all times.

There were effective working relationships between the home and other healthcare and support providers. This ensured people in the home had access to a range of services to meet their needs.

There were effective systems in place to reduce the risk and spread of infection. We saw that the home was clean, tidy and hygienic.

We looked at the equipment that was available in the home and found that most had been risk assessed. However, issues identified in an electrical systems inspection had yet to be followed up by the home.

There were rigorous recruitment and selection processes in place to ensure that staff employed at the home were safe to work with vulnerable people. An induction and skills programme was in place for new and existing staff to follow.

There was an effective complaints system in place and concerns were listened to so that improvements could be made to the quality of service in the home.

We spoke with three people who used the service. They told us they were happy living at Bethune Court. One person said that the staff were friendly. Another person told us that their visitors were always made welcome when they visited Bethune Court.

We spoke with three members of staff. They all liked working in the home. They told us there had been an increase in staffing at weekends. They told us this enabled them to have the time they needed to support the people who used the service.

We looked at the training records and saw evidence that demonstrated that staff had taken part in a number of training activities since our last visit. There were records to show that staff had been receiving monthly supervision.

We reviewed four care plans. Three were found to be up to date with regular monitoring records in place. Daily records were detailed and linked to the requirements of the care plan.

We examined four medication audits and twenty self audit forms. They were all completed in full. There was evidence that audits were being monitored by the manager, action taken and lessons learned when appropriate.

People told us that they liked living at Bethune Court. People appeared relaxed, happy and were involved in activities taking place in the home. One person told us, ' I do what I like.' Another person told us they had lived in the home for a number of years and they were very happy. We found evidence that showed people using the service were encouraged to be independent and have choice over their daily lives. We observed people being treated kindly and with dignity and respect.

Staff told us they received training and supervision to help them with their role. However, records showed that this training and support was not up-to-date. We looked at a number of documents developed to support care and these were not always completed fully.

There were a number of systems in place to review the quality of service being provided at Bethune Court to maintain standards. Surveys were used to capture how people felt about living in the home anonymously and there were monthly meetings with people to ensure their needs were being met.