Harpenden Bethesda Home

Updated 11 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

Harpenden Bethesda Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Harpenden Bethesda Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 18 April 2023 and ended on 27 April 2023. We visited the service on 18 April 2023

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and 5 relatives and friends about their experience of the care provided to their family members. We spoke with or had feedback from 11 members of staff including the registered manager, deputy manager, nominated individual, care and ancillary staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 2 people’s care records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 11 May 2023

About the service

Harpenden Bethesda Home is a residential care home providing personal care to up to 25 people. The service provides support to older people, some of whom are living with dementia, in a purpose-built building. At the time of our inspection there were 11 people using the service.

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

There were monitoring processes in place to help ensure a good standard of service. Quality assurance systems were used to identify any areas that needed further development and to help ensure remedial actions were implemented. However, the overview and use of these systems needed to be more robust and carried out in accordance with the quality assurance policy so that gaps in records or themes and trends were identified.

People felt they were safe and well supported by the service. Individual risks were assessed, although these needed to be reflected throughout some care plans, but staff were aware of these and supported people safely. Reviews of events and accidents were carried out and any actions needed were carried out. Medicines practice, audits and checks needed to be more robust as we identified an error. Staff had received training and competency checks. Staff knew how to report any concerns about a person’s safety or welfare. People told us there was enough staff to meet their needs. Infection control systems were in place.

Staff received training for their role, although some updates were due, and people felt they had good knowledge and skills. Staff felt supported by the provider and management team. People told us staff their preferences and choices.

People and relatives told us staff were kind and caring, and they were happy living at Harpenden Bethesda Home. Interactions observed were very positive, staff responded to people in a way that anticipated their needs and demonstrated they knew people well. All observations found staff to be attentive and caring about the people they supported.

Staff enjoyed working at the home and wanted to ensure people were happy and well cared for. Care plans included all information needed to support people safely and in accordance with their wishes and preferences. These were reviewed regularly. However, work was needed to ensure that key information was carried across all areas of the plans.

The registered manager was well known in the home, people, their relatives and staff spoke positively about them and the management team. They worked closely with the nominated individual to help ensure a good service for people.

People, their relatives and staff felt their views about the service were sought and listened to. People and staff told us that the registered manager was often around the home and the service was well run.

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.

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 the service under the previous provider was good (published 14 May 2019).

Why we inspected

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.

We received concerns in relation to the management of risks and governance, staff training and records. As a result, we undertook a focused inspection to review the key questions of safe and well led only.

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 changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harpenden Bethesda Home on our website at www.cqc.org.uk.

Recommendations

We recommend that the management team ensure records accurately reflect people’s risks and ensure governance systems are consistently followed to identify any shortfalls and allow themselves to implement actions that may be needed. Also, that action plans have a clear completion date to help ensure work is completed.

Follow up

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