Byron Lodge Care Home

Byron Lodge is a residential care home providing personal and nursing care for up to 61 people. At the time of our inspection there were 43 people living at the home. Some people using the service were living with dementia.

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

Systems in place to monitor the service were not always effective. Audits identified areas of some improvement but some issues were not actioned in a timely way. For example, the sluice bin had been identified for replacing on 6 March audit, but this was still not replaced when we carried out our inspection. This audit also identified that equipment should not be stored in bathrooms, but this was still evident on inspection and storerooms required attention, especially the decommissioned bathrooms.

People did not always receive person centred care. We observed the meal service on 2 units and found the meal time experience poor.

We found some concerns regarding medicine management. The provider could not always evidence people were given their medicines as prescribed. Following our inspection, the manager took appropriate actions to ensure systems improved.

We carried out a tour of the home with the manager and the home generally, was visibly clean, but deep cleaning was required to ensure equipment, furniture and storerooms were clean. Storerooms required organising and sorting out. The manager confirmed action had been taken following our inspection.

Risks in relation to people's care and support were in place. However, some people had lost weight and there were limited evidence to show how this was being addressed.

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.

Staff were aware of what actions to take to safeguard people from the risk of abuse. The manager kept a record of safeguarding concerns and monitored the outcome.

Accidents and incidents were analysed but there was lack of evidence to show what actions had been taken to mitigate future risks. Following our inspection, the manager introduced a system to improve this analysis.

People, relatives, and staff spoke highly of the new manager and felt she was approachable and taking action 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 good (published 25 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, infection control, and leadership. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Byron Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicine management and governance and leadership.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 is a care providing personal and nursing care, including people living with dementia. There were 48 people using the service at the time of the inspection. The service can support up to 61 people.

People’s experience and what we found

The home was predominantly clean and there were PPE stations situated at several points throughout the home. However, we identified some areas were not well maintained therefore, were not able to be effectively cleaned. The provider, since our inspection had addressed these areas.

We spoke with people who used the service and their relatives, and they were complimentary about the care and support they or their relatives received. However, many told us the communication could be improved and at times they did not feel listened to. The registered manager informed us how they would address this to improve communication.

People were safeguarded from the risks of abuse. The registered manager had improved systems to ensure staff reported any concerns immediately. Staff received training in this area and knew how to recognise and report abuse. Staff were confident that appropriate action would be taken to keep people safe.

Risks associated with people's care were identified and risk assessments were in place to minimise the risk. Staff were knowledgeable about risks associated with people's care. However, some risk when reviewed had missed information. The registered manager rectified this immediately.

Accidents and incidents were monitored, and trends and patterns identified. Lessons were learned when things went wrong.

People received their medicines as prescribed. Competency checks were carried out and staff were knowledgeable about medicine management. The provider had a robust recruitment procedure which ensured new starters were recruited safely.

We observed there were sufficient staff available to meet people's needs and to socially engage with them whilst adhering to the current restrictions due to the COVID-19 pandemic. Staff we spoke with felt there were enough staff available and were able to meet people's needs.

A range of audits took place to ensure the service was monitored and quality maintained. However, although the registered manager had identified shortfalls these were not always addressed in a timely way. Since our inspection this has been addressed.

The registered manager and the management team supported staff to deliver person centred care to people. The provider was improving engagement with people who used the service and their relatives.

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 11 January 2019)

Why we inspected

We undertook this focused inspection to check the service had addressed the safeguarding and whistleblowing concerns that had been received by CQC and the Local Authority. The concerns were in relation to risks not being managed. This report only covers our findings in relation to the Key Questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Byron Lodge’ on our website at www.cqc.org.uk.

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 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.

The home can accommodate a maximum of 61 older people. There were 31 people living at the home at the time of our inspection.

There was a manager in post at the time of our inspection. The manager had been appointed since our last inspection and their registration with CQC was in progress. 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 and associated Regulations about how the service is run.

At the last inspection on 25 June 2018, we found the previous provider was breaching regulations in relation to consent and governance. After the inspection, the previous provider sent us an action plan telling us how they planned to make improvements. Since that time a new provider had taken ownership of the home. At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breaches. This has helped to improve the service's overall rating to 'Good.' The provider, manager and staff had all worked together to achieve these improvements.

The tools used to assess people's capacity had improved, which meant they were effective in identifying when people may need support to make decisions. People's care plans were personalised and reflected all aspects of their care. Staff had clear guidance to follow about how to provide the care and support people needed.

People and relatives were complimentary about the caring nature of staff and the positive atmosphere. People had developed positive relationships with the staff who cared for them and enjoyed their company. Many staff had worked at the home for some years and knew the people they cared for and their relatives well. Friends and families were encouraged to be involved in the home.

The provider and manager formed a strong leadership team and provided good support to staff. Staff were committed to providing high quality care and felt valued by the provider and manager for the work they did. Staff had the training and support they needed to perform their roles. They worked well as a team to ensure that people received good care.

People's care was regularly reviewed with them and staff were appropriately deployed throughout the home so that people received the timely support they needed. They were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. Staff were friendly, kind and compassionate. They had insight into people's capabilities and support needs. They respected people's diversity and how they wished to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People that needed support to manage their medicines received this. People were supported to eat and drink whenever this was part of their agreed plan of care. They were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed.

Staff treated people with respect and supported them to maintain their independence. People had access to a wide range of activities and outings and to be involved in their local community. Staff ensured that no one became socially isolated.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and any improvements that were needed were acted upon. There were arrangements in place for the service to make sure that action was taken and lessons learned so the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems in place that were used to review all aspects of the service and deliver improvements whenever needed.

People knew how to complain and were confident that if they had concerns these issues would be dealt with in a timely way.

Further information is in the detailed findings below.

Byron Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Byron Lodge is a nursing home that accommodates up to 61 older people with varying support needs, including nursing and people living with dementia. Accommodation is provided at the service over two floors. There were 30 people using the service at the time of our inspection.

At our last inspection on 18 and 19 October 2017, we identified significant failings and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing, medicines, infection control, need for consent, meeting nutritional and hydration needs, person-centred care and good governance.

Following the last inspection, the provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection, the registered manager had left the service. A new manager was in place and they were in the process of submitting their registered manager application. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found the provider was still not meeting the requirements of Regulation 17. Quality assurance systems and procedures were in place but had not enabled them to effectively identify and address the shortfalls we identified during our inspection. We also identified a breach of Regulations 11 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The provider had not always sought people's consent and acted in accordance with the requirements of the Mental Capacity Act 2005.

Risks associated with people's needs had been assessed and planned for. Improvements had been made to how risks were managed. However, further time was required for improvements in documentation and monitoring to be embedded and sustained. Audits and checks in relation to risks associated with the environment had been monitored and equipment was safe and met people's needs.

Staff were aware of their responsibility to protect people from avoidable harm and safeguarding incidents had been acted upon. There were sufficient staff available to meet people's needs although the deployment of staff could be improved. Safe staff recruitment checks were in place and followed. Overall improvements had been made with the management of medicines and infection control; some shortfalls were identified that required further attention. Accidents and incident were recorded and analysed to consider lessons learnt.

We saw that staff obtained people's consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people's best interest had not been consistently completed. People's food and hydration needs were met and choices offered and respected. People's health care needs were assessed, planned for and monitored, but information available to staff to support these needs were not always clearly recorded.

People had support and encouragement to follow a balanced diet, and were involved in choices about what they ate and drank. Any risks associated with people's eating and drinking were assessed.

Staff received an induction; ongoing training and improvements had been made to the frequency of staff supervisions and appraisals. People lived in an environment that met their needs including any diverse needs, to ensure they were not discriminated against.

Staff were kind and compassionate although would benefit from further awareness of preserving dignity. Staff had developed positive relationships with the people they supported, they understood people's needs, preferences, and what was important to them. Advocacy information was available should people have required this support.

People and their relatives received opportunities to be involved in review meetings to discuss the care and treatment provided. People told us the opportunities to participate in a variety of activities was limited. The provider's complaint procedure had been made available.

The management team promoted a positive and inclusive culture within the service, Staff felt well supported and able to request additional support and guidance from the management team.

Quality assurance checks and audits were completed regularly and resulted in some improvements to the service. However they did not always identify shortfalls within the service.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear. The home is split up in to four units; Shakespeare and Ruskin providing nursing care and Wordsworth and Browning providing residential care. At the time of our inspection these were 44 people using the service.

At the time of our inspection there was a registered manager in post. 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.

Following the inspection Byron Lodge Care Home have notified the Care Quality Commission of a serious incident which is currently being investigated by the Safeguarding Authority.

The home had a dependency tool in place in care records which identified the level of support people who used the service required from staff. We observed staff interacting with people during our inspection and found there were times when the deployment of staff could have been managed more effectively. We spoke with people who used the service, relatives, visiting professionals and staff. They all felt there were not enough staff to meet people’s needs in a safe way.

Systems were in place to manage medicines safely. However, we found these were not always followed to ensure people received their medicines as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, we found these were not always followed.

The provider had a safeguarding procedure to ensure people were protected from abuse. However, some concerns had not been reported to the safeguarding authority.

Systems in place for infection prevention and control were not effective. The environment was not well maintained and therefore, could not be effectively cleaned.

We found that staff received training and support, but this was not always effective. For example staff had completed dementia training but lacked knowledge about assisting people who were living with dementia. Staff told us they did not feel supported by their managers and did not receive effective supervision.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found people’s best interests were not always clearly documented, did not always involve all relevant people and did not clearly detail the outcome. Decisions recorded were sometimes very general and not specific.

Mealtimes were relaxed and calm; however, staff did not always ensure people received adequate nutrition. Some people required a fortified diet to ensure they received adequate nutrition. There was little evidence to show that this need had been fulfilled. Some people’s food preferences were not respected.

We observed staff interacting with people and found they were kind and caring, but only interacted with people when carrying out a task. We also saw that staff had not recognised that some people were distressed and we had to inform staff that they required assistance.

We found care plans were in place and had been updated since our last inspection. We found for the most part people’s needs had been identified. However, we found they did not always reflect people’s current needs as they were not always reviewed when needs changed. We also observed lack of social stimulation and activities. People we spoke with told us they were bored. Staff we spoke with also told us there had been no activity co-ordinator for some time.

People we spoke with gave mixed opinions about how the registered manager handled their concerns. Some people did not feel listened to, but others felt their concerns had been dealt with satisfactorily.

Changes within the management team had impacted on the performance of the team. The nursing unit manager was no longer in post and another unit manager had not been consistently at work. However, the registered provider had not taken appropriate actions to ensure the units were managed effectively.

We found a lack of leadership and oversight on a day to day basis and communication between all was not effective at all levels of staff. Staff we spoke with told us they did not feel listened to, they said communication was poor and there was lack of direction. Systems in place to monitor the service had not been completed consistently. The quality and safety audits in place had not always been effective. For instance, the shortfalls that we found at this inspection had not been identified by the registered provider’s monitoring systems.

We found six continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

The overall rating for this service remains ‘Inadequate’ and the service will therefore remain in ‘special measures.’

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

Byron Lodge is a care home providing accommodation for up to 61 people. The home has four units, Browning and Wordsworth which provide residential care and Ruskin and Shakespeare which provide nursing care. The home is situated in the West Melton area and is approximately six miles from Rotherham town centre.

The service did not have a registered manager in post at the time 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. However, the deputy manager had been promoted to this position and was in the early stages of registering with the Care Quality Commission.

We found risks had been identified and measures put in pace to manage the risk. However, we found the risks were not always managed so people were at risk of harm. This showed the provider was not doing all that was reasonably practicable to mitigate risks associated with people’s care and treatment.

The provider did not have safe arrangements in place for managing medicines. We found that people did not always receive their medicines as prescribed. We found people were prescribed medication to be taken as and when required known as PRN (as required) medicine. However, there was a lack of protocols in place to guide staff in how these should be administered. The temperatures of the rooms used to store medicines was not always monitored or recorded to determine that they maintained the required temperatures. We also saw the fridge temperatures were not always recorded. It was therefore not evident if the required temperatures were maintained.

The premises and equipment used by people were not always clean and/or properly maintained. During our inspection we looked around the service. We found many areas were not kept clean and infection prevention and control policies were not adhered to. For example, store rooms were cluttered and not well organised. Many items were stored on the floor, which meant they were difficult to clean. We saw several dining chairs throughout the service which had ripped seats which could not be cleaned effectively. Other chairs were stained and marked.

We saw moving and handling slings were not labelled or stored appropriately. This meant the staff could not easily access them or know which size sling to use to ensure the correct sling was used for each person requiring moving with the mechanical hoist. Staff we spoke with were unsure of which sling was to be used for each person.

Overall, people we spoke with said there were enough staff on duty to meet people’s needs. However, some people felt that additional staff were needed. From our observations we found that there was enough staff around on the days we completed our inspection. However, we found staff lacked leadership, direction and were not deployed in an effective manner. This meant that people’s needs were not always met in a timely manner.

Some staff had not received appropriate support, supervision and appraisal necessary for them to carry out their duties. Staff were not always knowledgeable about people’s needs and there were some gaps in the training record.

Decisions made where people lacked capacity did not follow best practice and did not evidence decisions were made in a person’s best interest. We identified people’s conditions in relation to the authorised Deprivation of Liberty Safeguards (DoLS), were not being followed so some people were being deprived of their liberty.

The mealtime experience did not ensure people received adequate nutrition. Some people were not adequately supported which led to people leaving their meal.

People were not always treated with dignity and respect. We saw personal information belonging to people on display or not appropriately stored. We observed staff interacting with people who used the service and found that some staff interacted well. However, staff were task focused and we observed staff only interacted with some people to complete specific tasks. For example, we saw that people who spent time in their rooms were only spoken with when staff had to enter their rooms to complete a task, such as assisting with meals. There was a lack of social stimulation, especially for people who spent most of their day in their bedrooms.

We found people did not always receive care that was responsive to their needs. We saw many care plans had been rewritten in June 2016, yet we identified in most that we looked at had only been reviewed once since that date.

All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with the acting manager or any of the staff.

We found that there had been a lack of consistent managers at all levels and a lack of provider oversight and governance which had contributed to the decline of the service. Audits in place to monitor the quality of service provision were not effective and did not identify the concerns we had raised as part of this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear. The home is split up in to four units; Shakespeare and Ruskin providing nursing care and Wordsworth and Browning providing residential care. At the time of the inspection there were 49 people using the service.

The service did not have a registered manager in post at the time 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. The provider had employed a manager who was in the process of registering with the Care Quality Commission.

Following our last inspection of the service in October 2015, the home was rated inadequate and placed in special measures. The provider sent us an action plan explaining how they would address this and sent regular updates showing the progress they were making. We continued to liaise with the local authority and monitored intelligence we received about the home. At our inspection of 14 June 2016, we saw that a new management team was in place and improvements had been made.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed.

The staff we spoke with were very knowledgeable on safeguarding and whistle blowing policies and procedures.

We looked at people’s records and found they identified risks associated with people’s care and treatment. However, these were not always reviewed to ensure they were a current reflection of the person’s needs.

The provider had a safe recruitment procedure in place which involved pre-employment checks being made prior to the person commencing employment.

People were supported to eat and drink sufficient to maintain a balanced diet and snacks were available in-between. People we spoke with who used the service told us they liked the food and were given choice. We observed meal times and found people had different experiences depending on which unit they lived on. Some staff interacted well and recognised needs whilst some units were less organised.

We found there was enough staff with the right skills, knowledge and experience to meet people’s needs. However, staff told us at certain times they could do with more staff to ensure people’s needs were met in a timely way.

We looked at care records and found they contained a care plan entitled, ‘my decision making.’ This stated the level of capacity the person had and what, if anything restricted their capacity. We saw best interest decisions had been made in relation to areas where people lacked capacity.

We observed staff working with people and found they were kind and caring in their nature. Staff we spoke with were knowledgeable about respecting privacy and dignity and gave examples of how they would do this.

We checked people’s care records that were using the service at the time of the inspection. They told staff how to support and care for people to ensure that they received care in the way they had been assessed. However, we found that some people’s needs had changed and these had not been identified to ensure people’s needs were met.

The service had an activity co-ordinator who arranged social events in the home. However, we noticed that some people did not receive any activities or social stimulation.

The home had a complaints procedure and people we spoke with knew how to raise concerns if they needed to. We saw the manager had taken appropriate action when complaints had been received and had resolved them in a timely and effective manner.

We recognised that the new manager had implemented many changes which had impacted on the home in a positive way. People who used the service, their relatives and staff gave positive feedback about the manager. However, systems in place to ensure the service was of good quality required embedding in to practice.

People who used the service and their relatives were listened to and there were opportunities where they could raise issues and be part of the service development.