Byron Lodge Care Home Ltd

Byron Lodge Care Home Ltd is a residential care home providing accommodation for persons who require nursing or personal care to up to 28 people. The service provides support to older people, some of whom lived with dementia, and 16 people were cared for in bed. At the time of our inspection there were 25 people using the service, 1 of whom was in hospital on the first day of the inspection, and 2 people were in hospital on the second day of the inspection.

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

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed. Some areas of the service were not clean. We were not always assured that the provider was using personal protective equipment effectively and safely. Meals and drinks were not always prepared to meet people's preferences and dietary needs.

The service was not always well led. Records were not always robust and accurate. The provider had failed to identify issues relating to risk assessments, medicines management, infection control, mental capacity and person-centred planning. Their quality monitoring processes had not identified issues with records that we found on inspection.

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 and in their best interests; the policies and systems in the service did not support this practice.

People's care was not always planned in a way that centred on the individual and met the needs and wishes of people.

Most staff had received training relevant to their roles, however some staff required training in catheter care and fire drills to make sure they could meet people’s needs effectively.

Despite the feedback above, people and relatives told us staff were kind, caring and friendly. Comments included, “Care is good and atmosphere is good and activities are happening”; “They’re all so happy here. They’re really lovely. They really look after you” and “I felt at home straight away. I chose to stay here after my assessment from the hospital.”

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. Assessments of staffing levels were undertaken by the registered manager and regional manager. There were enough staff deployed to provide safe care. However, some people told us they sometimes had to wait for care.

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.

People were supported to access support from healthcare professionals. Most people told us they enjoyed their food. The provider had systems and processes in place to manage complaints.

Activities took place to stimulate people, this included some 1:1 activities for those cared for in bed. Activities did not meet everyone’s needs, we received mixed feedback from people.

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 01 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The directors for the provider had changed in December 2022, because the previous provider had sold their business.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led. As we found a breach of regulation in relation to mental capacity and DoLS and a breach in regulation in relation to planning people’s care we extended the inspection to include all domains.

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

We have identified breaches in relation to risk management, medicines management, infection control, managing nutrition and hydration, mental capacity and DoLS, care planning and effective quality assurance process at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Byron Lodge Care Home is a residential care home providing personal and nursing care for up to 28 older people. At the time of our inspection, there were 19 people using the service. Some of the people using the service were living with dementia and some people received their care and treatment in bed.

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

People told us they were content with the support they received. Their comments included, “I get all the help I need,” and “The staff are all helpful.” However, one person told us they felt staff were occasionally “abrupt” when they spoke to them. Relatives we spoke with were generally satisfied with the home, although some felt communication from some staff could be improved. For example, by not being as forthcoming with information about how a their relative was and telling them, “They are as well as can be expected”.

Care plans were complete, regularly reviewed and updated. Risks and people’s support needs had been assessed, and staff were aware of people’s needs and how to keep them safe.

People and their relatives felt there were enough staff and told us staff usually responded to support them in a timely way. Staff told us there were times when they were very busy, but felt they were able to deliver the support people needed.

The registered manager regularly assessed the amount of staff required to meet people’s needs and gave examples of when more staff were deployed to meet additional needs. Staff had received the training required to support people and keep them safe, including how to recognise abuse and how to report it.

Staff treated people with kindness, respect and compassion. People and relatives told us they knew how to make a complaint should they need to do so.

Audits completed by the registered manager and service provider were effective and promoted learning to improve the service.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 31 July 2019).

Why we inspected

The inspection was prompted due to concerns received about the safe care and treatment of people. These included people being frightened of speaking with staff, being told not to tell relatives if they were unhappy about their care, being got up and put to bed at restricted times, having bed rails in place as a restraining method, a lack of support with continence care and being told not to use the call bell to call staff. A decision was made for us to inspect using our targeted methodology developed during the Covid19 pandemic to examine those specific risks and ensure people were safe.

We undertook this targeted inspection to check on specific concerns we had. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Byron Lodge Care Home Ltd is a residential care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. Some people were living with dementia and some received care and treatment in bed. The service can support up to 28 people.

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

Risk assessments did not always have all the information staff needed to keep people safe. People who required equipment to help them to move had risk assessments in place. Risk assessments lacked clear guidance for staff about how to work with people safely, such as which loops to use when using the hoist. This put people and staff at risk of injury.

There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to risk management and management of people’s safety.

Medicines were stored, managed and administered safely. PRN protocols were in place for most people to detail how they communicated pain, why they needed the medicine and what the maximum dosages were. People’s topical medicines were not always managed in a safe way; records were not always clear about whether prescribed creams have been administered. This is an area for improvement.

Improvements had been seen across the service since our last inspection. The management team and staff had worked hard to make sure people received quality care and support.

People felt safe living at Byron Lodge Care Home. Staff had the knowledge and training to protect people from abuse and avoidable harm.

People had choice over their care and support and their choice, dignity and privacy was respected by staff. People told us staff were kind and caring and treated them well.

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. Activities were also provided for people who received their care and treatment in bed.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly they were referred to a fall’s clinic. Nursing staff worked closely with the GP and advanced care practitioner who visited the service regularly.

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.

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 07 June 2018) and there were five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, enough improvement had not been made and the provider was still in breach of two regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Byron Lodge Care Home Ltd 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. People received nursing and personal care.

Byron Lodge Care Home Ltd accommodates up to 28 people in one three storey building. There were 25 people living at the service when we inspected. A number of people received their care in bed. Some people lived with dementia.

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.

Not all risks had been managed safely. Risk assessments within the service had not been reviewed and updated following accidents and incidents to ensure that that accident did not happen again. Other risks to people such as risks of a person falling, sustaining injuries when taking medicines which thin the blood, moving and handling, diet and nutrition and developing pressure areas had been well managed.

The provider had not followed effective recruitment procedures to check that potential staff employed were suitable for their roles and had the skills and experience needed to carry out their roles. Appropriate numbers of staff had been deployed to meet people's needs. However, it was not clear how staffing levels had been determined as people’s dependency information was not used to calculate the staffing required. We made a recommendation about this.

Medicines had not been managed in a consistently safe way. Medicines were stored safely and securely within a temperature controlled environment. We observed a medicines round and observed the trained nurse explaining to people what medicines they were being administered and why. There was inconsistent practice in relation to records relating to medicines that were classed as controlled drugs (CDs) under the Misuse of Drugs Act 1971. We checked the stock of CDs and found that the number in stock did not match the expected number recorded in the CD book. We made a recommendation about this.

There was inconsistent monitoring and oversight of people’s nutrition and hydration needs. Records did not show that all people had been supported to eat and drink enough to maintain a balanced diet. People told us that they liked the food and we observed staff supporting people to drink regularly.

We observed that people made decisions about their care and treatment. Where people lacked capacity to make particular decisions, mental capacity assessments had taken place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had a system in place to track and monitor applications and authorisations, which was not always effective. We made a recommendation about this.

Care plans were person centred and provided details about how people preferred to receive their personal care. People had access to a small range of activities. The registered manager planned to improve activities and enable more people to utilise the communal areas.

People had been asked for their feedback about the service, it was not always evident that they had been listened to. We made a recommendation about this.

A programme of quality audits were in place but had not been effective in highlighting the issues we found at this inspection.

Registered person’s had not always informed CQC about serious injuries that had occurred. We made a recommendation about this.

The service had a friendly and homely culture and people told us they liked living at Byron Lodge Care Home Ltd.

People and relatives were engaged in the running of the service. The registered manager was a visible presence in the service and ensured that feedback led to learning and improvement.

Staff had received training in a range of courses relevant to their role. Staff received effective support from the management team.

People were protected from the risk of abuse by staff that understood their role in reporting any concerns.

People had effective assessments prior to admission. This meant that care outcomes were planned for, and staff understood what support each person required.

People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain. However, It was not always clear that advice supplied by healthcare professionals had been followed.

There was no easy to read menu available to help people living with dementia and people who found it difficult to choose their meals make an informed choice. We made a recommendation about this.

The service was clean and tidy and it smelled fresh. The premises and environment met peoples’ needs.

Staff treated people with kindness and compassion. Staff communicated with people in the way in which they preferred.

People and their relatives were consulted around their care and support. People's views and feedback had not always been acted on. We made a recommendation about this.

People’s dignity and privacy was not always respected. Staff encouraged people to be as independent as safely possible. Staff knew people’s needs well and people told us they liked and valued their staff.

People and their relatives knew how to complain and were satisfied that complaints had been managed effectively.

People on end of life care had a pain free, comfortable and dignified death.

During this inspection we found five breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.