L'Arche Bognor Regis Bethany

About the service

L’Arche Bethany is a residential care home providing personal care to 6 people at the time of the inspection. The service can support up to 6 people.

People’s experience of using this service and what we found

Right Culture: The provider did not always support the delivery of high-quality, person-centred care. Quality assurance systems and processes to maintain and develop the safety and quality of care were not always operating effectively. The provider had not done all of the things we had asked them to after the last inspection. People told us they liked the staff and liked the support they received. They enjoyed living at Bethany and their equality and diversity was respected.

Right Support: Staff supported people to take part in some activities and interests in their local area. People told us they were not doing some of the things they would like to do. This is an area that needs to improve. Staff supported people with their medicines in a way they wanted but we found some medicines were not managed well. People lived in shared accommodation. They had their own bedrooms which they were able to personalise. Staff carried out daily living tasks, such as cooking and cleaning, whilst actively supporting people to take part.

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

Right Care: People did not always receive the right support to keep them safe or well. People told us they received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 September 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We undertook this inspection to follow up on action we told the provider to take at a previous inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook an unannounced comprehensive inspection of the service on 26 and 27 May 2022. There were multiple breaches of legal requirements. Warning Notices were served in relation to the following regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014;

Regulation 9 (Person-centred care) Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance). The provider was required to be compliant with these regulations by 5 September 2022.

We undertook this comprehensive inspection to check whether the Warning Notice we previously served in relation to Regulations 9, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We have found the provider had not met the requirements of the Warning Notice for Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the safe, effective and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for L’Arche Bognor Regis Bethany on our website at www.cqc.org.uk.

Enforcement

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance.

In response to the serious concerns found during inspection we have imposed conditions on the providers registration for L'Arche Bethany.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

L’Arche Bethany is a residential care home providing personal care to six people at the time of the inspection. The service can support up to six people.

People’s experience of using this service and what we found

Right Support- People were not always supported to have the maximum possible independence, choice or control over their own lives. People did not have outcome focused support plans. Some practices restricted people’s independence and choice. People told us they were not supported to pursue their interests or achieve aspirations and goals. One person told us this was “Annoying” because they couldn’t choose what they wanted to do. People did not receive support in an environment that was well maintained, well equipped or well furnished. Staff and visitors to the service told us the poor condition of the environment and furnishing was long standing. One said, “It’s been like this for years, we just get used to it”. People told us they were not able to decorate their rooms or the communal areas.

There were enough staff to keep people safe. Staff enabled people to access specialist health support in the community.

Right Care - People’s care and support plans did not reflect people’s individual needs and aspirations. People’s care and support did not consistently focus on their quality of life or follow best practice. There was a failure to assess risks people might face and people were not encouraged or enabled to take positive risks. People were not provided with opportunities to try new activities tailored to them that enhanced and enriched their lives. We observed that people participated in group activities facilitated by L’Arche rather than pursuing their own individual interests or seeking opportunities for volunteering or employment. The provider had not fully considered people’s needs and wishes in the planning and deployment of staff.

People could communicate with staff and understand information given to them because staff understood their individual communication needs. Throughout the inspection we observed people communicating effectively with staff using Makaton sign language, pictorial prompts and verbal speech.

Right culture- People were not supported to lead inclusive and empowered lives. There was a failure to identify and mitigate institutionalised practices and risks associated with closed cultures. People could not be assured of receiving support based on transparency, respect and inclusivity. People shared their home with staff who lived alongside them. People told us they did not choose the staff who shared their home.

There was a strong emphasis on meeting people’s spiritual needs and valuing people as members of the L’Arche community.

Rating at last inspection

The last rating for this service was good (published 27 September 2018)

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to protecting people from avoidable harm, restrictive practices, safe care and treatment, medicines, staff skills and knowledge, person centred care and the management of the service. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

L'Arche Bethany provides care and support for up to six people with a learning disability and other complex needs, including autism and mental health issues. At the time of this inspection there were six people living at the home, all of whom were able to communicate verbally and independently.

L’Arche Bethany is a large three storey house. Rooms were of single occupancy. Communal areas included a large sitting room and a kitchen with a sitting area. The kitchen had access to a conservatory which was being used as a dining /activity room, overlooking an accessible garden to the rear of the property.

L'Arche originated in France in 1964 and is now an international movement that builds faith-based communities with people with learning disabilities. L’Arche Bethany is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at L’Arche Bethany are known as 'core members' and staff as 'assistants'. Due to the philosophy of L'Arche that people with disabilities live in a community, most assistants live in the service alongside core members, sharing all the facilities.

At the last inspection on 31 January 2017 we found the service was in breach of two regulations. The provider had failed to notify us of incidents which they were required to do as set out in regulations. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. Since the inspection of 31January 2017 the Commission have been notified of those incidents defined by the regulations as needing to be reported to us. This regulation is now met.

At the last inspection of 31 January 2017 we found the provider had not ensured the home was adequately cleaned and hygienic. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the home was clean and hygienic and there were no offensive odours. This regulation is now met.

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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At this inspection we identified some of the actions and decisions regarding the care of people were not always recorded. We have made a recommendation about this.

Staff had a good awareness of their responsibilities to protect people in their care and for reporting any concerns. People said they received a good standard of care.

Risks to people were assessed and care plans included details of measures to counter these risks.

Sufficient numbers of staff were employed to meet people’s needs. Staff recruitment procedures ensured only staff who were suitable to work in a care setting were employed.

Medicines were safely managed.

The home is a converted residential dwelling. The premises were safe and well maintained.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were comprehensively assessed and arrangements made to monitor and treat health care needs.

Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

People were provided with varied and nutritious meals. There was a choice of food at each meal and people said they liked the food.

Staff supported people to make their own decisions and to have as much control about their lives as possible. Staff were trained in the Mental Capacity Act 2005 (MCA) and in the Deprivation of Liberty Safeguards (DoLS). The provider liaised with relevant local authorities to seek their advice if there was an issue regarding someone’s capacity.

There was a culture of inclusion where people and their relatives were involved and consulted about care and the service provision. There was a family ethos and a sense of community at the home.

People received person centred care which was responsive to their needs. Care plans reflected people’s needs and preferences. People benefitted from a range of educational, social and recreational activities both within the home and in the wider community. This helped promote people’s life skills and independence. People’s communication needs were assessed and staff were skilled when interacting with people. Information was provided to people in a format they could more easily understand.

People, relatives and staff were able to contribute to decision making in the home. A relative described how they were involved in decisions and that a good dialogue and working relationship with the registered manager and staff helped ensure any issues were resolved. There were a number of audits and quality assurance checks regarding the safety and quality of the services, including seeking the views of people who lived at the home.

L'Arche Bethany provides care and support for up to six people with a learning disability and other complex needs, including autism and mental health issues. At the time of this inspection there were five people living at the home, all of whom were able to communicate verbally and independently.

L’Arche Bethany is a large three storey house. Rooms were of single occupancy. Communal areas included a large sitting room and a kitchen with a sitting area. The kitchen had access to a conservatory which was being used as a dining /activity room, overlooking an accessible garden to the rear of the property.

L'Arche originated in France in 1964 and is now an international movement that builds faith-based communities with people with learning disabilities. L’Arche Bethany is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at L’Arche Bethany are known as 'core members' and staff as 'assistants'. Due to the philosophy of L'Arche that people with disabilities live in a community, most assistants live in the service alongside core members, sharing all of the facilities.

It is a condition of the provider's registration that a registered manager is in post at this location. The service did not have a registered manager in post at the time of our inspection. 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. L’Arche Bethany has not had a registered manager in post since March 2016. The service was managed day to day by a house leader. A co-ordinator responsible for three other services of the provider supported the house leader in their role. The house leader was present during our inspection. The house leader told us, a permanent manager had been appointed but was not due to commence until April 2017.

At the last inspection, on 20 January 2015, we asked the provider to take action to improve how medicine errors were managed. We had identified that when medicine errors occurred prompt and appropriate action was not taken that ensured people received their medicines safely. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this inspection, we found that the actions had been completed.

At this inspection, we found a range of audits in place to measure the quality of care delivered, including environmental and cleaning checks. However, the environmental and cleaning checks were not always effective in identifying areas of concern such as cleaning and maintenance issues. Premises were not always clean or properly maintained. There was a malodour in the shower room. We found that hand towels and bars of soap were in use, which did not promote infection control and cleanliness. The cleaning schedules in place were ineffective.

Staff were aware of their responsibilities in relation to safeguarding. The house leader and staff were clear about when to report concerns and the processes to be followed in order to keep people safe. Although safeguarding incidences had been submitted to the local authority, the provider had failed to act in line with their legal responsibilities in notifying the Commission of one incident of an allegation of abuse and one person’s injury that required hospital treatment as required.

People were able to make choices, to take control of their lives and be supported to increase their independent living skills. Risk assessments and support plans were in place that considered potential risks to people. Strategies to minimise these risks were recorded and acted upon.

People told us the food at the home was good and they were offered a choice at mealtimes. People were supported to access healthcare services and to maintain good health..

There were enough staff on duty to support people and meet their needs. Appropriate recruitment checks were completed to ensure staff were safe to support people. Staff were sufficiently skilled and experienced to effectively care and support people to have a good quality of life. People told us that they were happy with the support they received from staff. Staff received training, supervision and appraisal that supported them to undertake their roles and to meet the needs of people.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The staff had a good understanding of their responsibilities in relation to MCA and DoLS. Staff sought people's consent about arrangements for their care. However, the provider had failed to notify the Commission of DoLS authorisations in accordance with the registration regulations.

Staff were kind and caring and people were treated with respect. Staff were attentive to people and we saw high levels of engagement with them. Staff knew what people could do for themselves and areas where support was needed.

People were supported to express their views and to be actively involved in making decisions about their care and support. Staff knew in detail each person’s individual needs, traits and personalities. People were supported to access and maintain links with their local community. The importance of community links and social inclusion was reinforced in people’s support plans. Support plans were in place that provided detailed information for staff on how to deliver people’s care.

The house leader encouraged people to work collaboratively to provide a holistic approach. Care was personalised and empowering, enabling people to take control of their lives and make decisions and choices. The house leader was committed to providing a good service that benefited everyone.

The vision and values of the service were known by everyone and embedded at L'Arche Bethany. As a result, relationships and spiritual needs flourished.

Weekly meetings were held with people and staff, which encouraged open and transparent communications between them and management. In addition, people were routinely asked their views about staff. People were routinely listened to and their comments acted upon. Weekly meetings took place where people could raise issues and a pictorial complaints procedure was in place that supported people to understand formal complaint processes.

Some areas of the environment were tired looking and in need of refurbishment. The house leader showed us maintenance plans that detailed improvements to be made and these were on going.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We also spoke with a member of staff and the manager. Both demonstrated a commitment to ensuring appropriate standards of cleanliness and infection control were maintained at the service. We found that since our last inspection steps had been taken and people were being cared for in a clean and generally hygienic environment.

People also told us that they were happy with the environment that they lived in. However, we found that some improvements were required with regard to infection control practices in order to promote people's safety.

We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with a member of staff. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered.

Systems were in place that monitored the quality of service people received and considered their views. People told us that they had regular meetings where their views and opinions were sought and acted upon.

We also found that recruitment practices provided protection to people who lived at the service.

We looked around the building which was clean and free from unpleasant odours. The bedrooms were personalised with photographs, books, computers and pictures.

During our visit we were unable to speak to any of the people who use the service. One person did return to the home briefly during the lunch period but they did not want to speak to us. We spoke with one member of staff. The home leader who was responsible for the day to day management of the home was unavailable.

Bethany has two registered managers. One who was responsible for the day to day management of the home and the other is the L'Arche care coordinator who is responsible for all the homes the L'Arche Bognor Regis Community. We were advised by a representative from the L'Arche community office that the person who is currently registered as the day to day manager has not been working at the home since 2010. The L'Arche representative told us they were not aware that the Care Quality Commission need to be informed that when a registered person ceases to manage the regulated activity.