Byron Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed. Changes and improvements implemented following the previous inspection needed to be embedded and sustained to support continuous service improvement.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was developing a proactive and positive culture of safety, based on openness and honesty. Members of staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were logged and recorded appropriately. Monthly quality review meetings took place where accidents and incidents were discussed and reviewed. Themes, trends, actions and improvements were identified. This process and approach and learning from accidents and incidents needed to be embedded and sustained to ensure continuous service improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Referrals were made appropriately to local health and care services and there was evidence of joined up care and support. Local partnership working arrangements had been recently improved and these improvements needed to be embedded into practice.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to for this to be achieved. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. The provider made referrals to the local Safeguarding Adults team appropriately and notifications were sent to CQC. We reviewed records about people’s Deprivation of Liberty Safeguards (DoLS) and we were assured the provider had made improvements to their record keeping. People told us they felt safe in the care home. One person said, “I have been here quite a long time. I am reasonably safe.” Another person told us, “I have been here for a few months. Yes, I am alright, I am fine. It’s better than living on my own. There are people around if you need anything.”

There had been improvements to recording keeping in relation to the Mental Capacity Act 2005 (MCA) and how people were kept safe when they lacked capacity. These improvements needed to be sustained and embedded into practice to ensure people were always supported in the least restrictive way. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and, if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do the things which mattered to them. People’s care plans had been improved followed our previous inspection but there were some instances where care notes did not always accurately record where care had been delivered, for example, around time-specific repositioning. We raised this with the management team and they agreed to take action. Improvements to care plans, risk assessments and reviews needed to be sustained and embedded to ensure people received care in line with their care plans.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had systems in place to record and monitor compliance and safety checks for the care environment. Information and evidence were well maintained and recorded. This improved approach to checks throughout the care environment needed to be embedded into standard practice. We asked people what they thought about the layout of the home and if it felt safe and homely. One person told use, “It is nice and comfortable here. It feels homely to a certain extent.” Another person said, “Yes, I am happy here. I can go where I like and I can go and sit outside to smoke.”

The provider made sure there were enough qualified, skilled and experienced staff. They made sure staff received effective support. Staff worked together well to provide safe care which met people’s individual needs. We reviewed recruitment records for members of staff and we were assured safe recruitments processes were followed. On the day of inspection, we observed members of staff were deployed effectively to meet people’s needs. However, feedback from both people and members of staff indicated there were times where it was felt there were insufficient numbers of staff to provide effective care and support. We shared this information with the management team. One person told us, “They never seem to have enough staff, sometimes I have to wait a long time for them to come and help me. Sometimes there are a lot of different ones. At the moment there are a lot of different ones, because it’s Easter.” Another person said, “I think there could be more staff on occasions, it can take a while for them to come. I don’t find it easy to know who the staff are.” A relative said, “I think there are enough staff at the moment, for the number of people here. I am not seeing as many agency staff as we used to. I think it’s better for [family member] that the staff know them. There seems to be more agency staff in today than usual.” A member of staff told us, “Recently, staffing levels have been reduced on both days and nights, which has made it more difficult to deliver fully individualised care and complete all work to a high standard. We are being asked to do more with less. Some people require 2 staff, and I ensure this is followed for safety. It is difficult to provide the best care possible sometimes. I feel numbers are looked at rather than a person's needs which is not very person-centred.” Another member of staff said, “We are generally able to respond to call bells promptly because we have enough staff to cover the required 'double-up' care, no resident is left waiting an unreasonable amount of time for essential care. The current levels allow us to complete our scheduled safety checks and repositioning rounds while still having the capacity to respond to unexpected incidents, such as a resident becoming unwell or distressed. If staffing levels ever fall below the safe limit due to sickness, the management is proactive in seeking agency cover to ensure the shift remains safe. Importantly, the staffing levels mean I don't feel I have to rush my interactions; I am able to provide the emotional support and reassurance many residents need during the night."

We shared feedback from people and staff with the provider and they assured us the service was not operating with reduced staffing levels. We reviewed dependency data and information which demonstrated staffing levels were consistently maintained above required levels. The care home had a significant reduction in occupancy following our last inspection and the provider had made a deliberate decision not to reduce staffing numbers thereby supporting stability and continuous improvements in the quality of care.

The provider had made improvement to how the risk of infection was assessed and managed. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Personal protective equipment was available to members of staff but was not always easily accessible in all care areas. We discussed this with the management team. The improvements seen at this inspection needed to be embedded and sustained.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The administration of medications was managed safely and we observed improvements had been made following the last inspection. Protocols for ‘as and when’ medication were in place and rotation charts and body maps were in place for people who needed pain relief patches. The new clinical lead had made changes and improvements to the medication administration processes and the recruitment of a new clinical nursing team. These changes needed to be embedded and sustained. A relative told us, “I think [family member] gets what they need. [The GP and pharmacy] were very good, they changed her tablets to liquid medication which helped her a lot. It’s a lot easier for her to take them. [The nurses] have liquid paracetamol in case [family member] needs any more, if they are in pain. [Members of staff] are very good. [Family member] has an injection every morning for their diabetes.” People told us they were informed when there had been problems with medications in the past. A relative told us, “I know there was 1 instance I was made aware of when 1 tablet had been missed. I think [the provider] sorted it out. They definitely let me know about things.”