About the service: Harpenden Bethesda Home is a care home and provides accommodation, care and support for up to 25 older people. At the time of the inspection, there were 10 people living in the home.

People’s experience of using this service:

People continued to feel safe living at the service. Risks in relation to people’s health, safety and welfare had been identified and action taken where appropriate. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. There were systems in place to monitor incidents and accidents and learn from these.

Staff were competent and knew the people they supported well. People’s care, health and cultural needs were identified so staff could meet these. People had their nutritional needs met. People were supported to maintain good health. Staff made referrals to health professionals when required. Staff worked within the principles of the Mental Capacity Act 2005 and ensured people consented to their care.

People continued to receive care from staff who were kind and caring. People’s privacy and dignity was protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences. One relative said, “[name] is very happy living at Bethesda and moved a long way to live here because their reputation is excellent as a care home.”

People received care that met their needs. Care plans gave details of how people would like their needs met. People took part in a range of group and one-to-one activities depending on their preferences. Information was displayed on how to make a complaint. Relatives also told us they knew how to complain.

People, relatives and staff told us the service was well managed and had an open and friendly culture. Staff said the service had a family atmosphere and they felt well-supported. The current registered manager and staff worked in partnership with other agencies to ensure people got the care and support they needed. This included local health and community services, such as district nurses and speech therapists.

Rating at last inspection: Good (report published 21 March 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

We carried out an unannounced inspection on 23 February 2016.

Harpenden Bethesda Home provides accommodation, care and support for up to 25 older people. At the time of the inspection, there were 19 people living in the home.

The service has 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had robust recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff were given the opportunity to get to know the people they supported.

People’s needs had been assessed, and care plans took account of their individual, preferences, and choices. Staff supported people to maintain their health and well-being.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service. The provider had effective quality monitoring processes in place to ensure that they were meeting the required standards of care and had a formal process for handling complaints and concerns which were investigated and resolved in a timely manner.

We inspected Harpenden Bethesda Home on 26 and 25 July 2013 and found them to be non complaint in the regulations that we inspected. We issued the provider with a warning notice and asked them to provide us with an action plan for the changes they would introduce to meet the regulations. We re-inspected the provider on 7 January 2014 to check that the provider was now compliant with the regulations.

We found that the provider had introduced new night staff and night procedures, the kitchen staff had also made changes to ensure people's nutritional needs were being met and care plans had also been updated and reviewed to provide staff with clear information when providing people with care. The provider was also now notifying the Care Quality Commission of any incidents within the home. Staff also told us that they now felt better supported by management and that previous issues had been resolved.

People who used the service told us that they were 'very happy' living at the home. and one person said that they 'would be rather lonely' without the home. They said that staff understood peoples individual needs and were all 'very kind'.

When we visited Harpenden Bethesda Home on 4 February 2013, we found people were very satisfied with the care and support they received. They told us they felt safe and the staff were friendly and looked after them well. One person said "The staff are friendly and it's all very good here."

We observed that people were offered care and support at a level which encouraged independence and ensured their individual needs were met. There was a relaxed atmosphere in the home, staff were friendly and courteous in their approach to people and interacted confidently with them. We spoke with nine people who lived at the Harpenden Bethesda Home, and the relatives of one person who was not available to speak with at the time of our visit. All commented positively about the quality of care and the conduct of the staff. One said, "The atmosphere is so nice here, no one is regimented."

We noted people were encouraged to express their views and were involved in planning their care and making choices and decisions about their care and support and how they spent their time. One person said, “It's great, we keep on the go but also have our private time.”

Within the care files we saw care documentation had been signed each month to confirm peoples' involvement and agreement with their particular care plans. The provider also had systems in place to monitor the quality of service provision in this home.

We visited Harpenden Bethesda home over two days on the 25 and 26 July 2013. When we arrived at the service on our first day we saw that people were well looked after and that their personal care needs had been met. When we spoke with people who used the service they said that they couldn't 'praise it enough'. They told us that they felt like 'this is home'. We were told that staff had 'so much patience' and that the home had a lovely 'spirit' which allowed people to follow the religion. We also spoke with a relative of a person we used the service and we were told that they were kept up to date with their relatives care but the home had not involved them in their relatives care plan. We were told that carers were very good but rushed off their feet.

We were made aware of some on-going staffing issues which the home had failed to resolve which was resulting in some staff being put under undue stress. We also found that due to staffing numbers not being appropriate, some of the personal care needs of people were not being met and some people were left at risk of poor care.