Byards Keep

Byards Keep provides care and support for younger adults who may be living with a learning disability or autistic spectrum disorder.

The service is registered to support up to eight people, and eight people were using the service when we inspected. This is larger than current best practice guidance. The service was also secluded from the nearby residential area, and next door to another of the provider’s services for people with a learning disability. However, the risk of these things having a negative impact on people was mitigated by the design of the building and staff who supported people to access and be a part of their local community.

Staff provided support in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence.

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

People were supported to live in a safe environment. Sufficient staff were deployed to meet people’s needs. Staff had been trained to identify and respond to any safeguarding concerns. This helped to keep people safe and prevent avoidable harm.

The environment had been adapted to meet people’s needs. People had privacy and personal spaces which had been designed and decorated according to their preferences. There were communal spaces and outside areas for people to use and enjoy. Some areas of the service had been marked for renovation.

Although the service was secluded from the nearby residential area, people were supported to take part in activities, to access their wider community and to do the things they enjoyed.

Staff were kind and caring. They treated people with respect and supported them to maintain their dignity. People responded positively to staff and shared friendly and caring relationships with them.

People’s needs had been thoroughly assessed and very detailed care plans and risk assessments guided staff on how best to support people. Staff showed a good understanding of people’s needs. They had received regular training, supervisions and spot checks of their performance.

Medicines were managed safely; staff had been trained and their competency regularly checked to make sure people received their prescribed medicines. The registered manager had taken proactive steps to stop the overuse of medicines.

Detailed communication assessments guided staff on how best to share information in an accessible way. Staff supported people to make day to day decisions and be in control of how they spent their time. 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 attended regular appointments and annual health reviews. Staff worked with other professionals for advice, guidance and support.

There were systems in place to manage and respond to any complaints about the service. The registered manage completed thorough investigations into any or concerns and acted to improve the service. Regular audits helped to monitor the quality and safety of the service and drive improvements.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

At the last inspection service was rated Good (report published 28 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Byards Keep is registered to provide accommodation with personal care for up to eight people with learning disabilities or autism. The home provides accommodation for six people in the main house with accommodation on the first floor and communal areas on the ground floor. In addition, there are two self-contained flats attached to the home. There were seven people living at the home when we inspected.

There was a registered manager for the home. 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 registered manager had put people at the centre of the care they received and worked with staff to ensure that people’s individual needs were met. Care plans fully reflected the care people needed to ensure their physical and emotional well-being and staff’s knowledge of people’s care needs was good. People living at the home and their families were fully involved in planning their care needs and people were engaged in planning their day to day activities and outings.

Staff were kind and caring and spent time with people building their confidence and their trust in the staff. This allowed people to access the community and to enjoy planned outings. In addition the added confidence meant that accessing healthcare was less scary for people as they had confidence that staff would ensure they were safe. Risks to people were identified and care was planned to keep people safe and people had access to appropriate healthcare when needed.

There were enough staff to meet people’s needs. Staff training and the ongoing support staff received from the registered manager meant that the care provide was calmly delivered, safe and effective. Safe recruitment practices ensure that staff were safe to work with people living at the home.

Staff had received training to keep people safe from abuse and the registered manager investigated any concerns raised. There were clear care plans in place around any need for restraint and staff training in diversion and distraction meant that restraint used was minimal and always to keep people safe from harm. Medicines were administered safely and information was available to support staff to administered medicines consistently and appropriately. People’s ability to eat safely and maintain a healthy weight were identified and monitored along with people’s emotional needs around access to food.

The registered manager was approachable and took action when any concerns or complaints were raised. They had gathered the views of people living at the home and their families and taken notice of their views to improve the quality of care people received. Systems used to monitor the quality of care provided were effective and the provider and registered manager kept up to date with changes in legislation and best practice.

We looked at service information, records and carried out a tour of the building.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A relative we spoke with told us, 'I am very impressed. (Name) is getting on quite well. The carers are excellent. Very good.' Another relative told us,'(Name) has come on so much. We have loved it. She does really well.'

Byards Keep was responsive to the needs of the people who used the service.

Byards Keep had a nominated infection control lead. A member of staff confirmed this and told us, 'We have an infection control champion. Any infection control concerns are reported to (name).'

We found Byards Keep to be well led. Staff we spoke with told us, 'We are well led since (name) came. She is very kind and will help where needed. She is very approachable. She has experience. It is a lot more settled now.' We spoke with relatives of people who used the service. Comments included, 'The home is well led. The staff are pleasant. There always seems to be a lot of staff. Staff are very nice and very welcoming.'

Staff we spoke with described Byards Keep as warm, welcoming, friendly atmosphere and a very person centred approach. Another member of staff told us, 'It is fun here. It is all about the people who live here. Making sure they get joy and fulfilment in everything they do.'

We spoke with two people but others had complex needs which meant they were not able to describe their experiences to us. We therefore used a number of different ways to help us understand everyone's experiences. For example, we looked at records, including personal care plans, we spoke to the manager and staff who were supporting people and we observed how they provided that support.

People were given support to make choices and decisions for themselves wherever they could do so, and staff clearly understood each person's way of communicating their needs, wishes and choices. We saw that people were supported in a way that reflected their care plans.

Where they were able to people told us things like, 'Go and talk to the staff if I was not happy' and 'Staff look after me, I like them.'