This comprehensive inspection took place on 16 January 2019 and was unannounced. We last inspected Bethany House Care Home in March 2018. We found the provider had breached the regulations related to safe care and treatment and good governance. We rated the home as requires improvement.

At this inspection we found the provider continued to breach the regulations related to safe care and treatment and good governance. This is the second time we have rated the service as required improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led, to at least good.

We found evidence that some improvements had been made to the service to protect people from harm. However, there remained areas of concern which required improvement to ensure people’s continued health, safety and well-being.

Bethany House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides nursing and personal care for older people and people living with dementia or a physical disability. The home is a detached 31 bed purpose built care home. It is set out over two floors. At the time of our inspection there were 30 people using the service.

We observed that people could enter or leave the building through unlocked doors without staff being aware. This posed a risk of harm to all people living at the service.

We found doors to sluice rooms, the cleaners cupboard and laundry were left open and accessible to anyone living at the service. This meant people were not protected from the potential hazards and risks associated with equipment and chemicals stored in these rooms.

Where people required the use of bed rails to prevent them from falling out of bed, we found safe practices were not always being followed to protect people from harm.

The provider had an infection control policy in place to help protect people from the risk of infection. However, we found this was not always being practiced which meant that people were not being protected from the potential spread of infections.

We found new systems were being introduced to continually improve the service through quality monitoring. However, we found the current governance systems had failed to identify the concerns found during this inspection.

Medicines management had improved following our last inspection.

People said they were well cared for and told us the staff were kind, considerate and caring. Care records provided staff with a summary of people’s needs and preferences. People told us they had been involved in developing their care plans.

Staff had a good understanding of both safeguarding and the provider’s whistle blowing procedure. They told us they wouldn’t hesitate to use the procedure to keep people safe.

Staffing levels had improved and were sufficient to meet people’s needs. People told us staff were reliable and responded to their needs well.

There were robust recruitment procedures to ensure new staff were suitable to work at the service.

Incidents and accidents were logged, with details recorded of the action taken to keep people safe. These were monitored to identify any patterns and trends.

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

Care plan audits were being undertaken regularly to ensure any change of need or issues could be addressed quickly.

Staff were well supported and received the training they needed, including a suitable induction for new staff. Records confirmed supervisions, appraisals and training was up to

This inspection took place on 6 February 2018 and was unannounced.

Bethany House 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. At the time of inspection the service was full with 31 people living there.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2011. 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 last inspection of the service was carried out in December 2015 and found that the service was meeting all the requirements of Health and Social Care Act 2008 and associated Regulations and rated them as good.

At this inspection we found that the standards at the service had deteriorated and required improvement.

We found concerns with the administration of medicines and the provider was following unsafe practice which was not within best practice guidelines.

Plans were not in place to minimise all risks to people who used the service. For example where a person self-administered their medicines or if a person was an insulin dependent diabetic.

People were at risk of harm from scalding due to high temperatures from the tap in their bedroom sink and due to windows opening wider than health and safety guidelines recommend.

Not all staff received a fire or full evacuation drill which meant at the time of an emergency people could be at risk.

Audits were not taking place for health and safety. The audits that were taking place were not effective in identifying the issues we found.

Due to these concerns we sent the provider an urgent action letter requesting them to take immediate action to address the concerns and keep people safe.

The majority of people enjoyed the food provided and were offered choice.

The premises were very plain without any contrasting colours and did not have any dementia friendly adaptations. We have made a recommendation about this.

Staff had received all the training they needed to carry out their roles effectively. However, nurses had not received up to date percutaneous endoscopic gastrostomy (PEG) training. PEG feeding is a means of providing nutrition and hydration to people through a feeding tube inserted into the stomach. We were aware of one person with a PEG at the time of the inspection. Staff were fully supported from supervisions and a yearly appraisal.

People who lived at the service were safeguarded from abuse and potential abuse. People told us that they felt safe at the service and that they trusted staff. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and demonstrated a basic understanding of the requirements of the Act. The registered manager understood their responsibilities in relation to the DoLS. Evidence of consent was sought.

Comments from people highlighted there were not enough staff on duty. Staff we spoke with said they felt staffing levels were difficult when they had sickness.

People said staff were kind and caring, however, many said they did not like to disturb them [staff]. People felt they were not receiving baths as often as they w

The inspection took place on 14 and 15 December 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Bethany House Care Home on 20 January 2014, at which time the service was compliant with all regulatory standards.

Bethany House Care Home is a residential home in Newton Aycliffe providing accommodation and nursing care for up to 31 people who require nursing and personal care. There were 31 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

We found that there were adequate numbers of staff on duty in order to meet the needs of people using the service.

Safeguarding principles, types of abuse to look out for and relevant contact information should people who used the service, relatives or staff have concerns were clearly displayed throughout the service. Members of staff displayed a good knowledge of safeguarding issues and a clear understanding of warning signs to be mindful of and their prospective actions should they have such concerns

We saw risks to people were managed through risk assessments and associated care plans. These risks were reviewed each month and we saw when relevant information was provided by healthcare professionals this was incorporated into care planning and risk assessment.

We found the service had systems in place for ordering, receiving, storing and disposing of medicines, including controlled drugs. Administration of medicines was generally safe and adhered to the National Institute for Health and Clinical Excellence (NICE) guidelines.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, whilst records of interviews were detailed and specific to the role.

The service was clean throughout, with a range of infection control measures in place, including two domestic assistants on duty at the time of inspection.

Training was relevant to people’s needs, with staff having completed communication training recently to help support their engagement with people who could not verbalise their wishes. Other recently completed training included: dementia awareness, infection control, manual handling, first aid, person-centred care, safeguarding, death, dying and bereavement, equality, diversity and inclusion and medicines administration. When we questioned staff about the practicalities of a range of these areas, they were able to give detailed and informed answers.

Staff had a good knowledge of people’s likes, dislikes and life histories and built a rapport with the people they cared for. This was facilitated by a key worker system, whereby staff had responsibility for individuals, leading to trusting relationships and a greater continuity of care.

Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required.

People had choices at each meal as well as being offered alternatives if they did not want the planned meal options. People told us they enjoyed the food and we observed calm and attentive interactions between staff and people they supported during lunchtime. We saw the service had successfully implemented a tool to manage the risk of malnutrition. The service’s approach to supporting people who required specialised diets was praised by a dietitian.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make th

At the time of the inspection there were twenty-seven people who used the service at Bethany House. During the inspection we were able to observe the experiences of people who lived at the home and people were able to tell us about their experiences. One person told us, “I would say it is very good here. I like my accommodation and I am happy with my care here”. We also spoke with the four care staff on duty, the nurse and the manager. We spoke with the relatives of people who lived at Bethany House, one of which told us, “The staff are really so helpful. They listen well. If I need anything they are there straight away”. Another relative told us, "I am very happy with the care my mother receives here”.

We spent time with the people who used the service as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff encouraged people to make their own choices and decisions. We saw staff understood each person’s different needs, for example, when they required additional support.

We saw that staff supported people to make choices about how they spent their day and the range of activities offered. On the day of our visit some of the people who used the service went out to various day centres.

We saw that staff treated people with dignity and respect and supported them to retain as much independence as possible. One person told us, “It was difficult coming here. But now I am here the staff have been so good and help me when I need it”. We saw that people had freedom of movement around their home and could spend time in their bedrooms whenever they wanted. We saw that each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet the people’s physical needs.

“I am looked after very well in here.”

“It’s alright, I have no complaints.”

“The staff are very good, they will always help you.”

“We have regular residents’ meetings every month so we can talk about things.”

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that people who used the service had their care and welfare needs met.

We found that staff had been well supported to deliver care and treatment safely. We were able to speak with four staff on duty at the home. All of the staff told us they were well supported by their manager.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

During our visit we spoke with several people who used the service and with their relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering and were polite with them.

One person said, “I feel that I am well supported.”

People at the home said they felt involved in decisions about their care.

One person told us, “I am very much in control here.”

People told us they were happy with the support they received from staff.

One person told us,

“I am very pleased with the quality of staff, I was pleasantly surprised.”

People said their care was monitored by the provider and the manager to make sure that it was meeting their needs.

One person said, “The one in charge has a good handle on things.”

When we visited the home we found some people were unable to tell us directly about their experiences and views of their care. However, we did talk with relatives that were visiting and saw staff practices as they worked with people to meet their needs.

One person’s relative said, “My (relative) has kept her dignity, she is smart and well kept and spotlessly clean.”

People who lived at the home told us “It is lovely here, beautiful” “Lovely carers, lovely food, lovely place.” “I know it is expensive but we get well looked after, kept clean and everything.” and “I don’t think you can fault it. I am involved in my care plan, everything is talked over and I give consent to my treatment. There are flexible routines to do what you want”.