Byron Court Care Home

We found the following examples of good practice.

The service had made the decision that until none of the people living in the service were testing negative for coronavirus no new admissions would be undertaken. The service supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely, such as calls with friends and loved ones and dedicated support time from staff members.

People at extreme risk and those that were isolating were supported in a manner to suit their needs. Were possible they remained in their own rooms to maintain a familiar environment. Specific staff were allocated to support all their needs, including their meals and cleaning to limit contact with other staff and reduce any risks.

The service had arrangements for booking visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Visitors were able to access window visits, garden visits and visits in a specific room that was accessed from outside without the need for visitors to enter the service.

Byron Court is a residential care home providing personal and nursing care to 40 people aged 65 and over at the time of the inspection. The service is registered to support up to 52 people.

We found the following examples of good practice.

The service had made the decision that until none of the people living in the service were testing negative for coronavirus no new admissions would be undertaken. The service supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely, such as calls with friends and loved ones and dedicated support time from staff members.

People at extreme risk and those that were isolating were supported in a manner to suit their needs. Were possible they remained in their own rooms to maintain a familiar environment. Specific staff were allocated to support all their needs, including their meals and cleaning to limit contact with other staff and reduce any risks.

The service had arrangements for booking visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Visitors were able to access window visits, garden visits and visits in a specific room that was accessed from outside without the need for visitors to enter the service.

Byron Court is a residential care home providing personal and nursing care to 40 people aged 65 and over at the time of the inspection. The service is registered to support up to 52 people.

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

People and their relatives said the home was a safe place to live and there were systems in place to protect people from abuse. People and their relatives were happy with staffing levels at the home, which we had highlighted as an area for improvement during our last inspection. We saw people were attended to promptly by staff throughout our inspection and one person said, “The staff always come when I need them; I just buzz.”

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.

People and their relatives gave us positive feedback about the food and drink at the home, along with the support provided by staff. One person commented, “The food is good and plentiful.” Staff supported people to access other healthcare services when needed and the healthcare professionals we spoke with gave positive feedback about the quality of care being provided.

People and relatives gave us positive feedback about the staff at the home and the quality of care being provided. One relative commented, “My [relative] can be very difficult but [relative] is always treated with care and dignity. We observed staff treating people with dignity and respect throughout our inspection.

People’s care plans were person-centred and gave staff the information needed to support people safely and effectively. People gave us positive feedback about the activities at the home. One person said, “There are always activities and I do try to join in.”

Quality assurance at the home had improved after we highlighted this as an area for improvement during our last inspection. There was also a positive, friendly and caring culture amongst the staff.

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 12 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the safety and cleanliness of the environment, staff lacking dignity and respect for people living at the home and lacking training to support people living with dementia. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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 Court 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.

Byron Court accommodates up to 54 people across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia.

At the time of our inspection there were 39 people living in the home.

A manager was in post, however they had not yet registered with the Care Quality Commission. 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 manager had been in post for the past three months.

We last inspected the home in December 2017 and we rated the service requires improvement overall.

This is the fourth consecutive time the home has been rated ‘requires improvement’. We plan to meet with the provider to discuss this, and any changes they plan to make to ensure this rating improves to at least ‘good.’

During our last inspection in December 2017, we found breaches of regulation in relation to governance. This was because auditing systems were not always robust in identifying missing information in people’s records. We saw during this inspection, that the registered providers approach to quality assurance had improved. However, there were still some discrepancies in records which showed that governance systems, despite being improved, were still not as robust as they should be. We have made a recommendation concerning this.

Our observations and conversations with staff evidenced that there were not always enough staff, particularly on the top floor of the home. We have made a recommendation concerning this.

People told us they felt safe living at Byron Court.

Staff were able to explain the course of action that they would take if they felt someone was being harmed or abused, this was reflected in the organisation’s safeguarding policy.

We saw that risk assessments were clearly accessible for staff and appropriate plans were in place to manage those risks. We saw that risk assessments differed from person to person depending on their level of need.

The manager retained comprehensive records relating to each staff member. Full pre-employment checks were carried out prior to a member of staff commencing work.

We saw that all firefighting equipment had been checked, and new equipment was in place in various parts of the home to help people evacuate safely. There were other environmental checks in place such as the gas and electricity, we spot checked some of these certificates and they were in date.

Medicines were safely stored in medicine trolleys in a locked clinic room. Arrangements were in place for the safe storage and management of controlled drugs. Some people were prescribed topical medicines (creams). These were stored safely and body maps were routinely used to show where topical creams should be applied.

Staff had the correct skills to support people effectively. We viewed the training matrix which evidenced that staff had all been booked to attend courses, and some courses had recently taken place.

Staff received a one to one supervision every eight weeks, and all staff told us that the manager had an open door policy where they were able to request a supervision if they needed one. Appraisals took place annually.

New staff were required to undertake a twelve week programme of induction training which was aligned to the principles of the Care Certificate.

We saw that various improvements had been made to the home since our last inspection. The manager discussed with us that the registered provider was accommodating when it came to redecoration and design of the home.

People were supported with their eating and drinking needs. There were menus available for people to be able to choose what food they wanted. The meal choices were also displayed on a board in the dining room.

People were assessed prior to them being admitted to the home. The initial assessment process we viewed focused on people's needs and choices while taking into account the type of care and support they required.

People were supported to access medical care when they needed it. Each person’s care plan contained a log of professional’s visits.

The home was working with accordance with the principles of the Mental Capacity Act 2005. Any required authorisation to deprive people of their liberty were in place. During this inspection we found that people’s capacity was routinely assessed.

We received positive comments with regards to the caring nature of the staff.

We observed staff interaction with people. We saw that people were treated with kindness and respect and consideration was given to people’s feelings.

Staff we spoke with described how they protected people's privacy during personal care. This included closing doors and windows and covering people up with towels and blankets.

Care plans were signed by people who were able to do this. For people who were not able to sign their own care plans we saw this had been done via a best interest process.

There was detailed information around people's backgrounds and any hobbies or interests they had before coming to live at the home. There was information in people’s care plans which described how they wished to be supported with their clinical needs.

All information was safely secured at the registered address and was not unnecessarily shared with others in accordance with General Data Protection Regulation principles.

There was a programme of activities on the communal board, and people told us they liked the activities.

People’s equality and human rights were respected. People were supported to follow their religious beliefs and engage in friendships within and outside of the home. Equality and diversity support needs were assessed from the outset as part of the initial assessment process.

Complaints were managed and responded to in line with the registered providers complaints procedure.

Everyone we spoke with, without exception, told us that the home had improved since the new manager had taken up post. All of the staff we spoke with said the manager was approachable and they felt they could raise any concerns with them.

We saw that team meetings were taking place regularly, the last one had taken place in November 2018 and we viewed the minutes of these, as well as the previous months.

The service also regularly gathered and analysed feedback from people living there, the staff, and relatives. We saw that no issues had been raised in the last feedback report.

The service worked well with the local hospitals to support people to safely transition into Byron Court.

There were policies and procedures in place for staff to follow, the staff were aware of these and their roles with regards to these polices.

We had the opportunity to discuss lessons learnt with the manager who gave us an example of how they had tried to promote a healthier team dynamic within the home.

The manager was aware of their roles and responsibilities and had reported all notifiable incidents to the Care Quality Commission as required. The ratings were clearly displayed in the communal area from the last inspection and on the registered providers webpage.

Byron Court 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.

Byron Court accommodates 54 people across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia.

At the time of our inspection there were 36 people living in the home.

A manager was in post and they were in the process of becoming registered with the Care Quality Commission. 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.

We last inspected the home in November 2016 and we rated the service requires improvement overall.

Some paperwork and audits were not organised in a way which reflected good practice. Medicine audits could not be located by the provider and manager despite the provider providing assurance these audits had recently taken place. We did see some evidence of other regular audits and director oversight even though this was not always documented. Therefore it was not always possible for us to see what actions had been taken and how the service was improving. Manager feedback and action points on incident and accident forms was not always completed. External auditors had visited the home and given action points to the service to help them improve. It was not always clear when actions had been implemented as these were not documented anywhere.

We spoke at length with the manager who was new in post about this. They assured us they were putting documentation in place which would help support them adhere to the provider’s own governance requirements.

Medications were managed well. People were getting their medications correctly and on time, and procedures in relation to covert medication were documented. Covert medication is medication which is disguised in food or drink so the person does not realise they are taking the medication. This can only be agreed following’ best interests’ discussions with interested parties including GP involvement. We did not see a record of who was in receipt of covert medication, but the nurse we spoke with knew this information. We raised this with the manager at the time of our inspection who rectified this.

Risk assessments in relation to falls, nutrition and hydration, pressure area care, and moving and handling were regularly reviewed and completed accurately. We saw that when there had been a change to a person’s care needs the corresponding risk assessment had been changed to reflect this.

There were sufficient number of staff on duty to support people appropriately. At the time of our inspection there was a high usage of agency nurses, however our conversations with them indicated they worked at the home often enough to get to know people well.

Staff were able to describe the course of action they would take if they felt someone was at risk of abuse or abuse had occurred. This included reporting the concern to their line manager or speaking to external professionals. We discussed some safeguarding concerns, and where concerns had been substantiated. We looked at what additional actions and learning opportunities had been taken by the service from this.

Staff were recruited safely and all checks were carried out in accordance with the provider’s own recruitment policy. This included satisfactory references and a criminal background check.

Systems and processes were in place to prevent the spread of infection at the home. Hand sanitiser was available on all floors.

Staff had the correct skills and knowledge to enable them to care for people safely and effectively. The training matrix we viewed showed that staff had been trained in a range of subjects, and training was updated when needed. There were certificates in staff files to show the training courses they had attended.

People were supported to eat and drink by staff if they required it. Where specialist dietary needs were identified, guidance and support from external organisations was sought and acted on. Staff documented what people ate and drank to assure they were not at risk malnutrition. These records had been filled in correctly.

The service worked closely with external healthcare professionals to ensure that information about people’s care and support was communicated well. There were frequent visits from district nurses and GP’s which evidenced people had access to healthcare services when they needed them.

The manager and the staff had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. People’s consent was recorded for most areas of care, and where they were not able to consent a ‘best interest’ process was recorded.

People could not always remember whether or not they had been involved in the development of their care plans. Some care plans were signed by people where they had the capacity to do so; however care plans for other people showed no evidence of the person’s involvement.

There was information in each person’s care plan with regards to their likes, dislikes, routines and preferences. Information was recorded with regards to people’s backgrounds, hobbies and interests.

Care plan’s evidenced that each person had been consulted with prior to them coming to the home in order for staff to develop a good understanding of how each person required their support to be delivered.

People told us they could make decisions regarding their care and support and there was documentation in place which evidenced that people who lived at the home were consulted with regularly. Care plans also showed that people were getting care which was meaningful and right for them.

At the time of our inspection the home was in the process of being redecorated and the lift was not completely free functioning. We saw that the provider had made arrangements for a new lift to be installed and provisions had been made on the upper floors of the home, such as extra staffing, more activities, and new seating area. We did see one of the bathrooms was being used temporarily as a smoking area which we expressed concern over due to the smell of smoke in the surrounding hallway. However, this had been risk assessed and was just temporary until the lift was fully operational. Since our inspection we have received feedback that the lift is fully operational.

We received positive comments about the staff, and observed kind pleasant interactions between staff and the people who lived at the home.

Staff were able to describe how they protected people’s dignity and respected their wishes when providing care.

Complaints were listened to and addressed in line with the provider’s complaints procedure.

People were supported with their wishes to have a pain free and dignified death, and staff had undergone training with regards to how to support people and their families.

The general feedback from staff and people who lived at the home was positive regarding the registered manager and the directors of the service. We saw there had been lots of improvements regarding the environment of the home, most of which were still on-going.

You can see what action we told the provider to take at the back of the full version of this report.

This inspection was to follow up on concerns that were identified at our last inspection in April 2016 and to check if the provider had made improvements. During our last inspection we found nine breaches of the Health and Social Care Act 2008. The home was judged as ‘inadequate’ overall and placed into ‘Special Measures.’

During our last inspection in April 2016 we found the provider was in breach of regulations relating to risk assessments, staffing, person centred care, consent, complaints, nutrition and hydration, premises and equipment, safeguarding and governance. During this inspection we found that improvement had been made in all areas and the provider was no longer in breach of these regulations.

Byron Court is a care home proving personal care and nursing care. It is registered to provide accommodation for up to 53 adults who require nursing or personal care. There is a separate unit for people who have dementia. The building is large three storey property. A passenger lift provides access to all areas of the home.

There were 44 people living at the home during the time of our inspection.

A manager was in post and they were in the process of becoming registered with the Care Quality Commission. 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.

We found that even though some improvements had been made regarding the application of the Mental Capacity Act and Deprivation of Liberty Safeguards, the provider was not always following a best interest process or clearly documenting this. We saw examples of this in the records we viewed. The provider had improved enough to not be in breach of this regulation, however we have made an recommendation about this.

Staff were able to describe the course of action they would take if they felt someone was being abused or harmed in anyway. Staff had recently undergone training in this subject. During our last inspection we found safeguarding concerns were not always handled correctly and the provider was in breach of these regulations. During this inspection, we found that all concerns had been reported appropriately, and the provider was no longer in breach of this regulation.

We identified during our last inspection that the services approach to risk assessment was not always robust and risks which affected people were not always documented appropriately. We found the provider in breach of these regulations. We found during this inspection, this had improved, and risks to people’s safety and welfare had been adequately assessed and documented. The provider was no longer in breach of this regulation.

There were regular checks in place on the environment and we observed the environment was clean and tidy. During our last inspection we observed that fire doors were wedged open which would compromise the health and safety of people living at the home if there was a fire. We observed during this inspection that the fire doors were being used correctly and were not wedged open. The provider was no longer in breach of regulations relating to this.

Staffing levels were consistent, and there was enough staff on duty to be able to support people in a timely manner. We found during our last inspection that there was a lack of staff presence in most areas of the home, and the provider was in breach of regulations associated to this. We found during this inspection this had improved, and the provider was no longer in breach of these regulations.

Staff were recruited safely and the provider ensured relevant checks were completed on staff before they worked at Byron Court.

Medications were well managed, and the manager had a process in place for the regular checking of medication. People received their medication on time.

Everyone we spoke with told us they felt safe living at the home. Families told us they felt the home was secure and they felt happy their relative lived at Byron Court.

Staff told us and records showed that they had completed training in topic areas such as safeguarding, MCA, infection control, medication and moving and handling. We saw certificates were in place for this training and the training matrix reflected this. Staff had been regularly supervised and we saw arrangements were in place for planned supervisions to occur in the next few weeks.

There was a programme of activities taking place in the home, and people told us they liked the activities.

The findings of our last inspection showed that people were sometimes not adequately supported to eat and drink what they needed, and this was not always documented for people who needed this type of support. We found during this inspection that this had improved and people were being supported to eat and drink enough and this was well monitored.

Everyone we spoke with told us they felt that the staff were caring and kind to them. Family members were complimentary regarding the care their relatives had at Byron Court.

During our last inspection, we found that people were not always in receipt of care which met their needs and found the provider was in breach of this regulation. We found during this inspection that there was a lot more personal information in people’s care plans. The provider was no longer in breach of this regulation.

During our last inspection we were unable to locate the complaints log, so we could not tell if complaints had been responded to. The provider was in breach of regulations associated to this. During this inspection we saw that there was a process in place for recording and managing complaints; we saw that complaints were documented and responded to in line with the provider’s complaints policy. The provider was no longer in breach of this regulation.

During our last inspection, we had concerns regarding the governance arrangements for the home as audits had not identified some of the issues we found during our last inspection. The provider was in breach of regulations relating to this. We saw during this inspection that this had improved and audits were now robust. The provider was no longer in breach of these regulations.

People were complimentary about the manager and the director.

The overall rating for this service is ‘requires improvement’ To improve the rating to ‘Good’ would require a longer term track record of consistent good practice

We will review this on our next inspection.

During this inspection we found that little improvement had been made, and there were still concerns which compromised the health, safety and welfare of people living at Byron Court.

Byron Court is a care home proving personal care and nursing care. It is registered to provide accommodation for up to 53 adults who require nursing or personal care. There is a separate unit for people who have dementia. The building is large three storey property. A passenger lift provides access to all areas of the home.

There were 48 people living at the home during the time of our inspection.

A registered manager was in post and was available for us to speak to for the first day 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.

During our last inspection in December 2015 we found the provider was in breach of regulations relating to medication, risk assessments, staffing, person centred care, failure to display ratings, and governance. The home was rated as ‘inadequate’ overall and placed in special measures.

During this inspection we found there were some audits in place around the cleanliness of the building and medication; however we found a lack of auditing systems around service provision. The current auditing system had failed to highlight the concerns we picked up on during our inspection.

We were told by staff that the staffing provision was not sufficient, and staff felt they could not spend time with people. There was no formal mechanism for determining what the staffing numbers should be based around people’s needs We observed one person was shouting for help and the staff did not come in a timely manner. . There was no staff presence in the lounge on occasions to ensure people’s safety and comfort.

During our last inspection in December 2015, we found the provider was in breach of the regulation associated with the management of risk for people who lived at the home. During this inspection we saw that some risk assessments were in place to help keep people safe from harm.

People were not always receiving care in accordance with their plan of care. Some people were not being weighed regularly, and other clinical tasks that people needed were not always being completed. Some people’s care plans did not contain information such as MUST scores and some information was difficult to find.

There was a process in place for gathering feedback from stakeholders and family members.

Equipment was in place to help support people with their personal care, and this was being regularly checked in accordance with national guidelines, however we saw the weighing scales were not always fit for purpose. One person’s weight was not documented accurately, and another person could not be weighed because the type of scales the home used were inappropriate.

We observed on more than one occasion, that a fire door was wedged open, which presented a risk to people living at the home and others in the event of a fire.

We found the laundry room, a store room and a cupboard were left unlocked and unattended. One contained substances which could be ingested or swallowed by people with dementia by mistake. An area of the home was being used to store wheelchairs which could pose a risk if people had to be evacuated quickly from the building.

Most of the staff we spoke with were aware of abuse. They knew what constituted as a safeguarding and how they would report this; however, we found that one alleged safeguarding incident had not been reported.

We found that the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not always being used appropriately. There was conflicting information recorded concerning the capacity of some people, and we found the best interest processes had not always been followed. We did see some forms of consent documented in care plans and we heard staff asking for peoples consent at some points during our inspection.

People told us they had enough to eat and drink, however we could not see any evidence of choice around mealtimes. There was no menu in place, and people told us they only knew what they were having on that day.

We found that referrals were being made to other professionals when they needed to be, although the action taken was not always documented.

There was a complaints’ policy in place. There was not a complaints log to check if appropriate action had been taken to address complaints.

Staff we spoke with were knowledgeable regarding people’s needs. The interactions we observed between staff and people who lived at the home were positive.

We saw some confidential information displayed in corridor which we highlighted to the deputy manager at the time. The deputy manager removed this information.

During our last inspection we saw the ratings from our last inspection in June 2015 were not being displayed as required. At this inspection the ratings from the December 2015 were displayed so that people were aware of how the service was performing. The provider was no longer in breach of the regulation.

During our last inspection in December 2015, we found people were not always protected against the risks associated with medication. We found during this inspection that improvements had been made and the provider was no longer in breach of this regulation.

People told us they liked the staff and felt safe living at Byron Court.

Staff were recruited appropriately and the relevant checks were undertaken before they started work to ensure they were fit to work with vulnerable people.

During our inspection we raised some concerns regarding how the service was being managed whilst we were present in the home. The provider took acceptable steps to address these concerns.

The overall rating for this provider is ‘inadequate’. This means that it has been placed into ‘Special measure’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in Special Measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We will report on any action we have taken once this has been completed.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found:

Is the service safe?

We last inspected Byron Court Care Home in April 2014. At that time we found there were not enough staff to meet people's needs, to ensure their care was delivered in a timely manner. Following the inspection the provider sent us an action plan which detailed how the service was to meet the requirements. On this inspection we checked to see whether improvements had been made.

We found the number of staff working throughout the home had increased since our last inspection. The manager advised us that they reviewed staffing levels regularly to ensure there were sufficient numbers of staff on duty to meet people's needs.

Is the service effective?

Care was planned and delivered in line with people's assessed needs and people's needs were regularly reviewed to make sure they received the care and support they required.

People who lived at the home and staff told us that staffing levels were sufficient to ensure people received the care and support they needed. We observed people had staff support with eating and drinking.

Is the service caring?

People who lived at the home described staff as 'caring' and 'kind'. People's comments included, 'Its very nice here' and 'I feel quite settled here.' Relatives we spoke with told us, 'This home is like a family. The staff are very good.'

We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

The service worked with other agencies to make sure people received the care and treatment they needed. GPs and other health professionals were referred to promptly when people required support with their health care needs.

Is the service well led?

The service was managed in a way that aimed to protect people's health, safety and welfare. The manager had taken action to improve the service through providing greater staffing levels. Staff we spoke with felt supported by the manager. Their comments included, 'Enjoy working here', 'The manager is making lots of improvements', 'Good training programme', 'Feel supported' and 'No complaints'.

At the time of our inspection the manager was not registered with CQC. The manager advised that they intended to submit their application for registration as a matter of priority.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. We found the majority of people who lived in the home were treated with respect and dignity by the staff. People who were able to share their experiences told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We looked at the numbers of staff working in the home. We carried out observations at lunch and tea time. People who required support with eating and drinking did not have dedicated staff to support them throughout a meal without interruption and with positive interaction. This was because the staff were completing other tasks at the same time. People who required verbal prompting from staff did not always receive this consistently as again staff were assisting other people.

We saw there were four people who needed support with eating and drinking and three people who required verbal prompting from staff. We saw there were times when only one carer was monitoring and supporting 11 people as staff supported others with personal care: We noted the longest time this occurred was 25 minutes. There was a risk therefore that a number of people did not receive care and support when they wished or when they needed it. There was little time for social interaction and inclusion by the staff with people, as they were undertaking a number of care duties to ensure people's health and well-being.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff understood when an application should be made and how to submit one. This meant that people would be safeguarded as required.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding, risk management and staffing.

Is the service effective?

Staff involved people where possible with the assessment of their health and social care needs. Some people told us they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking to staff that they had a good understanding of people's care and support needs and that they knew them well. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. There were no protected meal times. We saw visitors were present during an evening meal.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People who lived in the home commented, "It's a great place; the staff are very caring' and 'The staff can't do enough, it's really lovely.'

People using the service were at risk of not having their concerns and needs properly taken into account. Recently some decisions and changes had been made that people using the service were not involved in. There had been no forum for this to happen.

Is the service responsive?

Peoples needs were assessed before they moved into the home. Records confirmed people's preference and needs had been recorded and care and support had been provided in accordance with people's wishes. People completed some activities in and outside the service regularly. The provider employed an activities coordinator for 30 hours each week. The home had access to an adapted minibus, which helped to keep people involved with their local community.

People had access to health and social care professionals when they required them. Appointments and visits were recorded in the individual's care records.

Is the service well led?

The home did not have a Registered Manager in place at the time of our inspection. The manager had been appointed approximately 5 weeks ago. We informed the manager of the importance of being registered with the Commission. They agreed to submit the application as soon as they were able to.

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

People told us changes had been made in the home and they felt they should have been consulted. Residents meetings were not held to enable their views to be heard.

During our observations we saw that people were offered a choice of food at lunchtime. One person we spoke with told us that there was always something they liked offered from the choices of main meals and snacks. They said that they could have breakfast between certain times, to be able to have a lie in and could have a light or cooked breakfast if they wished. This showed people made their own choices.

On checking medication management we found that people received their medicines as prescribed. We found records regarding medication were accurate.

We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them and assisting them with around the building.