Byron Court

We expect Health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people.

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

People’s care and support was not always provided in a safe, clean, well equipped, well-furnished and well-maintained environment.

The service¿could¿show¿how they met the principles of Right support, right care, right culture.¿¿

People lead confident, inclusive lives which they have control. The ethos, values and behaviours of the management and staff support people to focus on areas of importance to them.

The needs and quality of life of people formed the basis of the culture at the service. Staff understood their role in making sure that people were always put first. We observed people receiving care that was genuinely person centred.

The leadership of the service had worked hard to create a learning culture. Staff felt valued and empowered to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. Staff felt confident to raise concerns and complaints and were passionate to improve outcomes for people.

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 protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People were supported to be independent and had control over their own lives. Their human rights were upheld.

We observed people receiving kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.

People’s risks were assessed regularly in a person-centred way, people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

We observed people making choices and taking part in activities which were part of their planned care and support. Staff supported them to achieve their aspirations and goals.

People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.

People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice.

People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal. Competency checks had been completed with staff to ensure they had the understanding and skills to deliver safe care.

Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

People were supported by staff who understood best practice in relation to learning disability and/or autism.

People and those important to them, worked with leaders to develop and improve the service.

Our last inspection found a breach of regulation 9 (Person centred Care). This inspection found people being supported in a way which promoted their interests and considered individuals future aspirations.

Our last inspection found a breach of regulation 10 (Dignity and respect). This inspection found staff were respectful of people they supported and provided care in a dignified manner.

Our last inspection found a breach of regulation 11 (Need for consent). This inspection found that people were encouraged to make choices and decisions whenever possible.

Our last inspection found a breach of regulation 12 (Safe care and treatment). This inspection found staff were knowledgeable and confident in raising safeguarding concerns. Systems had been reviewed to ensure the safe management and administration of medicines.

Our last inspection found a breach of regulation 17 (Good governance). This inspection found improvements had been made and an audit system had been implemented to identify and address failings of the service.

Our last inspection found a breach of regulation 18 (staffing). This inspection found staff had received additional training and competency checks had been completed by senior staff. This provided assurance that staff had the skills required to provide safe and effective care. Staff were supported by the management team and worked together as a team.

The positive conditions imposed following our last inspection facilitated the development and improvement found during this inspection. The management team had reviewed processes and had led the development of the service and delivery to people.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this inspection to provide assurance that the service is applying the principles of Right support right care right culture.

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

We found the following examples of good practice.

A communal area had been designated by the provider for people who had tested positive for COVID-19 and did not wish to remain in their rooms.

Weekly testing of staff was completed, and those living at the home were tested on a 28 day cycle. Assurance had been sought that agency staff did not work elsewhere and were included in the testing of staff for COVID-19.

Bryon Court is a residential care home providing accommodation and personal care to 7 people. The service was supporting 7 people in total who were living with a learning disability or autism.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that 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 using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The home was a large domestic style property. There were two identifying signs at the front of the home that it was a residential care home. A poster displaying the rating by the food standards agency was near the front door by the doorbell. The office had a large window at the front with a broken office blind at this window. When the lights were on it was obvious it was an office to a service. This is not in line with the values and policy of Registering the Right Support.

The service did not apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons.

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

This was an institutionalised service which did not always provide a safe, person-centred service for people which promoted their independence and rights.

There was ineffective leadership at the home. The registered manager was often not present, and the provider had not responded to this. There were clear failings at the home in terms of managing people’s safety, promoting a quality experience, and giving people opportunities in their lives. The provider’s own quality monitoring systems were inadequate at identifying the shortfalls of the leadership of the service and taking action to correct these.

These leadership failures led to a poor culture amongst the staff team, where people were not being put first. There had been an event when a member of staff had harmed a person. They eventually returned to work with no clear monitoring or oversight by a manager or the provider. Concerns had also been raised about a potential bullying culture in the staff team. Staff did not feel supported or valued by the leadership, which included the provider.

People’s safety was not routinely being considered with action taken to monitor their needs, to ensure they were safe. Risk assessments and plans for staff to follow had not been created when people experienced new risks to their safety and well-being. Action to seek health professional input or to try and push appointments for earlier dates was not happening. Staff were not seeking out the advice from professionals to support people’s needs before referrals were made or before a scheduled appointment took place to keep people safe. We needed to raise two safeguarding referrals during this inspection to the local authority because we were concerned about a person and the shortfalls in their care.

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 good practice. People did not have capacity assessments to check they consented to important aspects of their lives.

People’s independence with food and the promotion of healthy eating was not explored with them.

Staff spoke with people in direct unfriendly tones. Staff did not encourage friendly banter or conversations with people. Staff and the provider did not promote the environment as people’s homes. They did not involve them in making the space their home.

People’s interests and ambitions were not being explored or promoted at the home. People’s relationships were also not being supported in a safe way. Staff lacked an awareness of the importance of this.

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 16 June 2017). At this inspection the service had deteriorated significantly from which has resulted in multiple breaches of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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.

The inspection took place on 9 and 10 May 2017.

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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks and balanced these against people’s rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Robust recruitment processes were in place and staff were not employed until satisfactory checks had been completed. Systems were in place to ensure people’s medicines were managed in a safe way.

Staff received a robust induction programme. They were provided with on-going training to update their skills and knowledge to effectively support people with their care and support needs.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.

People were treated with compassion and kindness by staff. Each person was supported in a way that was individual to them and were encouraged to identify their own support networks in order to improve their independence.

People's needs were assessed and care records gave clear guidance on how people were to be supported. Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There was an effective complaints system in place which was used to drive future improvement within the service.

People and staff were positive about the leadership of the service and the support they were able to provide for people with complex healthcare needs. Staff engaged consistently and meaningfully with people who said they felt wholly involved in their care. Ideas for change were always welcomed, and used to drive improvements and make positive changes for people.

We visited Byron Court on 21 November 2013, and spoke with two people and three staff, including the newly appointed manager. People told us they were happy with the food choices they were given but the staff we spoke with told us they were concerned that the food that was used, may not be as nutritionally balanced as it could be.

We saw that there was sufficient food within the home for people and noted that people were given a choice of food options, with this being discussed as regular service user meetings. We were told by the manager (who was in the process of applying to be the registered manager) that there were future plans to improve the process of buying food for people and the way in which this was managed.

We observed positive engagement and interactions between staff and the four people in the home at the time of our visit, and saw that people were treated respectfully and given choices at all times. One person said. "Staff look after me very well. They are great."

We looked at four people's care records and found these to be regularly reviewed and relevant for people's assessed needs. We spoke with three members of staff on duty who had worked at the home for a number of years. Staff were knowledgeable about people's needs and likes and dislikes.

We saw that processes were in place to safeguard vulnerable people, and staff had a good understanding about the process to take if they had concerns.

We looked at staff training and the support provided for staff and saw evidence that staff received training relevant for their role. Staff said they were given the opportunity to discuss issues at staff meetings.

We found that both people's and staff members records were maintained securely and appropriately and protected people's confidentiality.

We observed that people were offered support at a level which encouraged them to be independent and ensured their individual needs were met. There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. The staff were friendly and polite in their approach, and interacted confidently with people.

We noted that people were encouraged to express their views and were involved in planning their care and making decisions about their support and how they spent their time. Some people were out at day centres at the time of our visit, and others were involved in carrying out tasks to support their personal development. People talked about the range of activities and entertainment that were available to them, and in particular plans that were in place for the Christmas celebrations. One person said "It's good, I can go out to the shops on my own."

Within the care files we saw that care documentation had been signed by the individual to confirm their involvement and agreement with their particular care needs. There were also clear records to reflect how people were encouraged to discuss their weekly activities and plan for forthcoming events such as holidays.