Bethesda Eventide Homes -Ipswich provides care for up to 26 older people. At the time of this unannounced inspection of 25 January 2019 there were 23 people who used the service. Some people were living with dementia.

At our last inspection on 1 December 2017, we found five breaches of Regulation of the Health and Social Care Act 20018 (Regulated Activities) Regulations 2014. Improvements were needed with assessing and mitigating risks to people, safe management of people’s medicines, consent to care and treatment, how people’s dietary needs was managed, staff training and how the quality of the service was monitored by the provider. We rated the service overall requires improvement. The key questions safe, effective, caring, responsive and well-led were rated requires improvement.

At this inspection we found that improvements had been made and were ongoing. The provider was no longer in breach of any regulations. We were encouraged by the progress made by the management team to turn the service around and the overall rating has changed from requires improvement to good.

A registered manager was 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.

Bethesda Eventide Homes-Ipswich 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. The service does not provide nursing care.

Bethesda Eventide Homes-Ipswich provided a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines. Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

People were cared for in a caring way by staff who understood their care needs. People and relatives were complimentary about the care provided and the approach of the management team and staff. Staff had developed good relationships with people. Staff consistently respected people’s privacy and dignity and promoted their independence.

People and their relatives where appropriate were involved in the planning of their care and people’s care records reflected their personal preferences. The care records were reviewed regularly and updated when people’s care needs changed.

People enjoyed a positive meal time experience and were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to access healthcare services. Input from other professionals was sought where concerns were identified about a person’s health or wellbeing needs. Information about people’s healthcare needs was shared appropriately with other professionals to ensure continuity of care.

The registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to pursue their hobbies and participate in activities that they chose. People knew how to complain and share their experiences. Their feedback was valued, acted on and used to improve the quality of the service.

There was visible leadership in the service. Improvements had been mad

Bethesda Eventide Homes - Ipswich 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. This service does not provide nursing care. Bethesda Eventide Homes - Ipswich accommodates up to 26 people in one adapted building. There were 26 older people living in the service when we undertook this comprehensive unannounced inspection on 1 December 2017.

There was a registered manager in place. 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.

This service was rated as Good at our last inspection of 7 August 2014. During this inspection of 1 December 2017 we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Caring Responsive and Well-led were rated Requires Improvement. We found breaches of Regulation 12: Safe care and treatment, Regulation 18; Staffing, Regulation 11: Need for consent, Regulation 14: Meeting nutritional and hydration needs and Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs. There were inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met. In addition, people’s care records which included guidance for staff about the risks in people’s daily living and how these were not robust and detailed. The ways that the service assessed risks to people and actions taken to reduce the risks required improvement to provide people with safe care at all times. There was limited evidence in records to show that people had participated in the planning of their care.

Improvements were needed in the systems in place for the safe handling of medicines. This included how staff recorded when people had been provided the medicines that were prescribed for administration externally, such as creams.

The majority of staff were trained in safeguarding, however, some staff had not received this training and some had not received it since 2013 or 2014, which meant that they were not provided with the most up to date information about how to keep people safe from abuse.

Staff were not provided with sufficient training to meet people’s needs effectively. Improvements were ongoing in how staff were provided with supervision.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People were supported to see, when needed, health and social care professionals. The service worked with other professionals involved in people’s care to improve people’s lives. However, the records maintained were kept in a confusing way.

Where there were concerns about people’s dietary intake referrals to other professionals were made. People were provided with high calorie supplements to assist people to maintain a healthy weight. However, the ways that people made their choices about meals needed improvement to provide a more person centred service.

Where incidents had occurred the service did not have robust systems in place to learn from these and use the learning to drive improvement in the service. The quality assurance systems in place which assisted the provider and the manager to identify shortfalls and ad

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

This visit was unannounced, which meant the provider and staff did not know we were coming. At the last inspection in 21 May 2013 there were no areas of concern in the standards we looked at.

Bethesda Eventide Homes – Ipswich is a residential home for up to 27 people who may be elderly, have a physical disability or be living with dementia. It does not provide nursing care. At the time of our inspection there were 26 people who used the service.

A registered manager was in post at the service.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law as does the provider.  We received positive feedback from people who used the service, relatives, staff and healthcare professionals.

People who used the service told us they felt safe, were treated with kindness, compassion and respect by the staff and were happy with the care they received.

Staff knew how to recognise and respond to abuse correctly. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.  Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the  Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed and authorised by appropriately trained professionals.

We found the service was meeting the requirements of the DoLS. The registered manager had a full and up to date knowledge of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. This meant that people who could not make decisions for themselves were protected.

Appropriate systems were in place to ensure that there were sufficient numbers of suitably skilled staff to meet people’s needs. In line with the provider’s policy and procedures newly employed staff received an induction and training. Records showed that staff received ongoing training, regular supervision, an annual appraisal and opportunities for professional development.   

We looked at people's care records. The records seen showed that care and treatment was planned and delivered to ensure people's safety and welfare. Information in the records provided clear guidance to staff on how to meet people’s individual needs and promote their independence.

People were supported to maintain their health and well-being. They attended appointments with other healthcare professionals such as opticians, physiotherapists, dentists and chiropodists.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals. We found that people were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

Throughout the inspection we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff were skilled at responding to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs.

People we spoke with told us that they felt confident and able to raise issues. Records seen showed people’s comments, concerns, compliments and complaints were responded to in line with the provider’s complaints procedure. People were listened to and any issues raised acted upon.

Robust systems were in place that assessed and monitored the quality of the service provided. The views of the people who used the service, their relatives, staff employed at the service and visiting healthcare professionals had been sought and acted on where required.

We talked with seven of the people who used the service. They told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us, “I am quite content, everything is fine.” Another person told us that they were happy with the service they received and that, “I have no grumbles.”

We observed that the staff were attentive to people’s needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed and interacted with each other.

We looked at three staff files and found evidence that showed that the service took all necessary precautions to ensure that they only employed staff that were of good character, had the skill and qualifications necessary to effectively care for older people.

We looked at the way that complaints were recorded and dealt with and saw that they were handled in line with the provider’s policy.

We saw that people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People who use the service told us that they were happy with the care they received at Bethesda Eventide. One person we spoke with commented that Bethesda Eventide was “the next best thing from home”. Another person we spoke with told us they were ”very happy” living at the home. One person told us that they had struggled to settle at the home to start with but were reassured when staff told them that Bethesda Eventide was now their home and they should treat it as such.

We talked with five of the people living in Bethesda Eventide Home. They told us that they liked living there, that the care staff showed them respect and worked hard to look after them. They also told us that they were comfortable in the service. One person told us that they were glad to be in the service, saying that the staff were, “Lovely people.” Another person said that the service was, “Excellent.”