Byron House

Byron House is a care home providing accommodation and personal care for up to 23 younger adults living with mental health conditions. At the time of inspection there were 21 people living at the home.

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

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 were cared for safely. Regularly reviewed risk assessments were in place to guide staff in supporting people safely. Staff had received training about local safeguarding procedures and understood how to identify and report any concerns they had for people’s safety and well-being.

People were involved in planning their care where they wanted to be. Care records were clear and reflected people’s needs and wishes. Staff knew people well and treated them with respect and kindness.

People were encouraged to express their views and opinions about the care and support they received. They knew how to raise concerns and make complaints if they needed to.

There were enough staff employed to meet people’s needs. Safe recruitment practices were followed to ensure staff were suitable for the roles they were employed to undertake. Staff were trained to support people with their individual needs such as prescribed medicines, healthcare and dietary requirements.

Systems were in place to minimise the risk of infections spreading in the home and national guidance related to the COVID-19 pandemic was followed.

Governance systems were in place to monitor and promote improvement in the quality and safety of the services provided for people. Issues we identified at the last inspection had been rectified and the provider was no longer in breach of regulations.

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 24 December 2019) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 House is a care home providing accommodation and personal care for up to 23 younger adults living with a mental health condition. At the time of inspection, there were 21 people living at the home.

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

During the inspection we found the registered provider was in breach of regulations in relation to safe care and treatment; need for consent; and good governance.

The service had been without a registered manager since 2 January 2019. A new acting manager was appointed in early January 2019 and held this role for a period of months before returning to their substantive role. Another manager was then appointed and came into post on 5 September 2019.

Work was required to address issues identified within people’s individual risk assessments to ensure they included how staff should care for people to keep them safe.

People had been referred to healthcare professionals to support their well-being. However, one person had lost a considerable amount of weight and they had not been referred to their GP for investigation.

Some people’s care plans included incomplete or incorrect mental capacity assessments. People were restricted in their access to a resident’s kitchen area.

Not all people’s care plans had been evaluated regularly to monitor people’s health and well-being and others were only partially completed. No formal audits had been carried out regarding people’s care plans. The regional manager told us care plans were in the process of being re-written. They also shared with us this was a task which had been included on the home’s action plan.

Staffing levels, recruitment and people’s medicines were managed safely. Staff had received training to support them in their role. However, refresher training for some staff was out of date. We have made a recommendation about this.

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 systems in the service did not support this practice.

People told us they felt safe living at the service. Staff were confident in their ability to identify and raise any safeguarding issues.

People were supported where necessary, by staff to access the community. People did have access to limited activities within the home.

The regional manager acknowledged work was required to address issues which had been identified prior to, and during the inspection. They had created an action plan for the home, the progress of which was monitored on a weekly basis.

Following the inspection, we sent the provider a letter which included our concerns which we had identified during the inspection. The provider responded to our letter, including a list of actions they would take to address our concerns. Following receipt of this letter, we carried out a follow-up visit to the service on 9 October 2019, to see if those improvements had been made. We identified minimal action had been taken, resulting in the majority of actions remaining outstanding.

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 good (published 4 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to safe care and treatment, need for consent and quality assurance processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to provide an action plan of how they plan to improve their rating to at least good.

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.

People living at the home were of mixed ages. Some people required more assistance either because of mental health needs or because they were experiencing difficulties coping with everyday tasks.

There was a manager in post, who had been interviewed by CQC for the registered manager’s post and was waiting for her certificate to arrive. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that people’s health care needs were assessed and care was planned and delivered in a consistent way through the use of their care plans. People were involved in the planning of their care. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans were put in place to minimise risk in order to keep people safe.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

People were treated with kindness and respect. Staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. There were menus on display so people could remind themselves of the choices they had made.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. On-going training was available for all staff.

People had been consulted about the development of the home and quality checks had been completed to ensure the home could meet people’s requirements. This included environmental checks both in and outside the building and there was a maintenance plan in place. There was an analysis of quality checks and lessons learnt were passed on to staff.

We found that risk assessments were completed to ensure the safety of people who used the service and there were effective systems in place for the safe administration and management of medicines.

We saw that staff knew the people they cared for very well and they had been supported to develop the appropriate skills and knowledge to deliver good standards of care.

Systems were in place to assess and improve the quality of care provided and learn from incidents.

At this inspection we saw the home had employed a member of staff with responsibility for cleaning who worked 30 hours each week. We observed a high standard of cleanliness in people's rooms. One member of staff told us, 'Having the cleaner has made a massive difference to us, we can concentrate on care now; the home has improved so much.'

At our last inspection we looked in the lounge used by people who smoked. We saw the floor and furniture was badly stained from cigarette stubs. The sofa was covered in cigarette ash. The extractor fan did not work and was clogged up with dust and dirt. The smell of smoke from this room affected many other parts of the home.

At this inspection we were told the company had decided to close the smoking room and it was to be refurbished in due course to become a general lounge. We saw the room had signs on the door to this effect, re-directing smokers to a courtyard area outside.

We saw many areas of the home had been completely refurbished including lounge areas and people's rooms. The acting manager told us, 'I sat down with people and chose the wall papers and paint colours, people really like it.'

Staff were attentive to people and spent time sitting and talking with them

We saw people ate appetising and fresh meals. People had access to sandwiches and drinks throughout the day. One person said, 'The meals are good and they listen to us about things we want.'

We observed a poor standard of cleanliness throughout the home. We looked in all the communal bathrooms and found dirty toilets, sinks and showers.

We were told the home had not had a cleaner or cook for over a year. The cooking was undertaken by the laundry assistant and the cleaning was provided by the care staff.

Staff we spoke with told us they did not have enough time to meet people's needs adequately as well as clean.