Bethany House provides accommodation and personal care support for up to two people with learning disabilities. At the time of our inspection there was one person living at the service.

At our last inspection in June 2015 this service was rated Good. At this unannounced inspection we found the overall rating for this service remained Good.

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 manager registered for this service is also registered for two other services local, nearby care services.

People remained safe at the service. There were sufficient staff available to meet people's needs and support them with activities both in and outside of the service. Risk assessments had been completed to enable people to retain their independence and receive care with minimum risk to themselves or others. Guidance had been provided for staff in steps they should take to mitigate these risks.

People’s medicines continued to be managed safely and people received their medicines as prescribed

There were enough suitably qualified, knowledgeable staff to provide people with support and guidance when they needed it. Staff had received appropriate training, support and development to carry out their role effectively.

Care plans were well organised, reviewed regularly and up to date. The plans contained information about what was important to people as well as information regarding their health care needs.

The staff were very caring and people had built strong relationships with staff. We observed staff being patient, kind and enabling people to maintain their independence. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.

Staff understood and promoted people's rights in line with the requirements of the Mental Capacity Act 2005 (MCA). Staff had received training in MCA and had good knowledge of the principles and how to support people to make decisions about their day to day living.

There were systems in place to ensure that staff were trained, regularly competency assessed to ensure that people received their medicines as prescribed. Medicines were stored safely and appropriate records of administration maintained.

Staff were provided with training in Safeguarding Adults from abuse. Staff were provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions about their everyday lives had been assessed and their consent was considered in the planning and provision of their care and support

People were supported to maintain good health and had access to external health care professionals when required. This included health screening and access to learning disability nurses, GPs, psychiatrists, chiropodists and dentists.

People were provided with the opportunity to participate in personalised, meaningful activities according to their assessed needs, wishes and preferences. People were encouraged to develop as much independence as possible and learn new life skills. People had access to and supported to be integrated into the local community.

The provider had a system in place to respond to suggestions, concerns and complaints. The service had a number of ways of gathering people’s views including; regular reviews, meetings and satisfaction surveys. The registered manager carried out a number of quality and safety monitoring audits to ensure the service was running effectively and to plan for improvement of the service.

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The inspection took place on 4 June 2015 and was unannounced.

The service provides care and support for up to two people with learning disabilities. At the time of our inspection one person was using the service.

There was a registered manager in post. 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.

Staff were trained in safeguarding people from abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns they may have.

Risks to people and staff were assessed and action taken to minimise these risks. The person was encouraged to remain as independent as possible and any risks related to this were assessed.

Staffing levels meant that the person’s needs were met. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff were recruited before posts were vacant.

Medicines were administered safely and records related to medicines were accurately completed.

Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for.

Consent was given before care and treatment was provided. Staff had received training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with legal requirements.

The person was supported with their eating and drinking needs and staff helped people to maintain good health by supporting them with their day to day healthcare needs.

Staff were very caring and treated people respectfully making sure their dignity was maintained. There was a lot of laughter and joking which created a very relaxed atmosphere. Staff were positive about the job they did and enjoyed the relationships they had built with the person they were supporting and caring for.

The person was were involved in planning and reviewing their care and was encouraged to provide feedback on the service. The person was supported to play an active part in their local community and follow their own interests and hobbies. Thought had been given to the provision of adaptations to support the person’s visual impairment.

No formal complaints had been made but informal issues were dealt with appropriately.

Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run.

Quality assurance systems were in place and audits were carried out regularly to monitor the delivery of the service.

The service supported one person with one to one staffing over a 24 hour period. We spoke with the person who used the service and they told us that they were happy and were able to make their own choices about how they lived their life. They told us "I like it here. I decide what I want to do- nobody tells me. They can't stop me doing what I want! ". We saw that they had a busy life with many activities including work in a local charity shop. They told us "I really like working in the charity shop - I do all different things".

We found that their care plan was centred on their needs and preferences and that it assessed and minimised any associated risks to make sure that they were safe. We found that the service provided a variety of fresh food and supported the person to eat a balanced diet. We saw that staff were trained to administer medicines safely and that records related to medicines were organised and well maintained.

We spoke with the member of staff on duty and looked at staff records and rotas. We found that staff were appropriately skilled and experienced and we observed them providing care and support in a sensitive and respectful manner.

One person lived at this service. They were provided with support on a one to one basis 24 hours per day to meet their individual needs. We spoke with the person who used the service who told us they were very happy there. They said, “This is my home, I am happy.”

We viewed the care file for the person who lived in the service and spoke with one carer and the registered manager. The care plan was person centred and involved the person who used the service who made decisions about their care with support from staff.

On the day of our inspection the person who used the service had been out for the majority of the day. They told us, “I am always so busy here, always stuff to do, I am never bored.”

We observed interactions between the person who used the service and care staff. The interactions were friendly, warm and kind. The person who used the service appeared at ease with the carers. They told us, “All my carers are nice people.”