We carried out this unannounced inspection of Brighton & Hove Bethesda Home on 25 July 2017. We previously carried out a comprehensive inspection at Brighton & Hove Bethesda Home on 23 June 2015. We found areas of practice that needed improvement. This was because we identified issues in respect to the analysis of incidents and accidents. Incidents and accidents were not monitored and analysed over time to look for any emerging trends and themes, or to identify how improvements to the service could be made. The service received an overall rating of ‘good’ from the comprehensive inspection on 23 June 2015.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made. The overall rating for Brighton & Hove Bethesda Home remains as ‘good’.

Brighton & Hove Bethesda Home is located in Hove. It provides accommodation with personal care and support to 22 older people, some of whom were living with varying stages of dementia, along with healthcare needs such as diabetes and sensory impairment. One of the conditions of residency is that residents are members of the Gospel Standard Churches, or that they regularly attend their chapels. The service is set over one floor. On the day of our inspection, there were 15 people living at the service.

Brighton & Hove Bethesda Home belongs to the organisation the Gospel Standard Bethesda Fund. The Gospel Standard Bethesda Fund is a Christian organisation standing by the distinct position of the Gospel Standard articles of faith, and aims to run its homes on Christian principles. The Gospel Standard Bethesda Fund has additional services in Harpenden, Hertfordshire and Studley, Wiltshire.

Accidents and incidents were recorded and analysed and people told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider continued to have arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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 supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People felt staff were skilled to meet their needs and provide effective care. Additionally, people enjoyed taking part in meaningful and appropriate activities both in the service and the community.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and they reported that they had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training upda

The inspection took place on 23 June 2015. Brighton & Hove Bethesda Home was last inspected on 5 August 2013 and no concerns were identified. Brighton & Hove Bethesda Home is located in Hove. It provides accommodation with personal care and support to 22 older people, some of whom were living with varying stages of dementia, along with healthcare needs such as diabetes and sensory impairment. One of the conditions of residency is that residents are members of the Gospel Standard Churches, or that they regularly attend their chapels. The service is set over two floors. On the day of our inspection, there were 19 people living at the service.

Brighton & Hove Bethesda Home belongs to the organisation the Gospel Standard Bethesda Fund. The Gospel Standard Bethesda Fund is a Christian organisation standing by the distinct position of the Gospel Standard articles of faith, and aims to run its homes on Christian principles. The Gospel Standard Bethesda Fund has additional services in Harpenden, Hertfordshire and Studley, Warwickshire.

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.

Systems were in place for the recording of incidents and accidents. However, incidents and accidents were not monitored and analysed over time for any emerging trends and themes, or to identify how improvements to the service could be made. We have identified this as an area of practice that requires improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “The staff are kind. They look after me well and I feel safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People and their relatives told us they enjoyed the activities, which included singing, bible readings, prayer, gardening and trips to the chapel and local areas of interest. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “The staff are very caring and do everything for me and always maintain my dignity”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

During our inspection we spoke with six people who used the service including a couple who were receiving respite care for two weeks. We also spoke with five staff members; these were the registered manager, a senior care worker, two care workers and the cook.

We also took information from other sources to help us understand the views of people who used the service, which included resident meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, “The carers here are very helpful and look after me well.” Another person commented, “The staff are marvellous and so caring. Nothing is a problem for the staff here.”

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service.

The people who used the service were supported to have adequate nutrition and hydration. People were given the choice of food and drink to meet their diverse needs. One person who used the service told us, “The cook is really good. There is a varied menu.”

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their jobs.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who use the service.

During our visit we saw that people were being treated with dignity and respect and people’s independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were polite, friendly and helpful and that their privacy was respected whilst they were supported to maintain their independence. One person told us that staff were ''always most respectful of your personal dignity'.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to the manager of senior person on duty.

Staff we spoke to and records we reviewed, demonstrated that staff were suitably experienced and skilled to support people living in the home. One staff member told us that Bethesda 'is a great place to work' and another said that the staff team were 'really good' at supporting residents.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks.