This inspection took place on 18 December 2018 and was unannounced. Byron Court 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.
Byron Court accommodates up to 54 people across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia.
At the time of our inspection there were 39 people living in the home.
A manager was in post, however they had not yet registered with the Care Quality Commission. 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 manager had been in post for the past three months.
We last inspected the home in December 2017 and we rated the service requires improvement overall.
This is the fourth consecutive time the home has been rated ‘requires improvement’. We plan to meet with the provider to discuss this, and any changes they plan to make to ensure this rating improves to at least ‘good.’
During our last inspection in December 2017, we found breaches of regulation in relation to governance. This was because auditing systems were not always robust in identifying missing information in people’s records. We saw during this inspection, that the registered providers approach to quality assurance had improved. However, there were still some discrepancies in records which showed that governance systems, despite being improved, were still not as robust as they should be. We have made a recommendation concerning this.
Our observations and conversations with staff evidenced that there were not always enough staff, particularly on the top floor of the home. We have made a recommendation concerning this.
People told us they felt safe living at Byron Court.
Staff were able to explain the course of action that they would take if they felt someone was being harmed or abused, this was reflected in the organisation’s safeguarding policy.
We saw that risk assessments were clearly accessible for staff and appropriate plans were in place to manage those risks. We saw that risk assessments differed from person to person depending on their level of need.
The manager retained comprehensive records relating to each staff member. Full pre-employment checks were carried out prior to a member of staff commencing work.
We saw that all firefighting equipment had been checked, and new equipment was in place in various parts of the home to help people evacuate safely. There were other environmental checks in place such as the gas and electricity, we spot checked some of these certificates and they were in date.
Medicines were safely stored in medicine trolleys in a locked clinic room. Arrangements were in place for the safe storage and management of controlled drugs. Some people were prescribed topical medicines (creams). These were stored safely and body maps were routinely used to show where topical creams should be applied.
Staff had the correct skills to support people effectively. We viewed the training matrix which evidenced that staff had all been booked to attend courses, and some courses had recently taken place.
Staff received a one to one supervision every eight weeks, and all staff told us that the manager had an open door policy where they were able to request a supervision if they needed one. Appraisals took place annually.
New staff were required to undertake a twelve week programme of induction training which was aligned to the principles of the Care Certificate.
We saw that various improvements had been made to the home since our last inspection. The manager discussed with us that the registered provider was accommodating when it came to redecoration and design of the home.
People were supported with their eating and drinking needs. There were menus available for people to be able to choose what food they wanted. The meal choices were also displayed on a board in the dining room.
People were assessed prior to them being admitted to the home. The initial assessment process we viewed focused on people's needs and choices while taking into account the type of care and support they required.
People were supported to access medical care when they needed it. Each person’s care plan contained a log of professional’s visits.
The home was working with accordance with the principles of the Mental Capacity Act 2005. Any required authorisation to deprive people of their liberty were in place. During this inspection we found that people’s capacity was routinely assessed.
We received positive comments with regards to the caring nature of the staff.
We observed staff interaction with people. We saw that people were treated with kindness and respect and consideration was given to people’s feelings.
Staff we spoke with described how they protected people's privacy during personal care. This included closing doors and windows and covering people up with towels and blankets.
Care plans were signed by people who were able to do this. For people who were not able to sign their own care plans we saw this had been done via a best interest process.
There was detailed information around people's backgrounds and any hobbies or interests they had before coming to live at the home. There was information in people’s care plans which described how they wished to be supported with their clinical needs.
All information was safely secured at the registered address and was not unnecessarily shared with others in accordance with General Data Protection Regulation principles.
There was a programme of activities on the communal board, and people told us they liked the activities.
People’s equality and human rights were respected. People were supported to follow their religious beliefs and engage in friendships within and outside of the home. Equality and diversity support needs were assessed from the outset as part of the initial assessment process.
Complaints were managed and responded to in line with the registered providers complaints procedure.
Everyone we spoke with, without exception, told us that the home had improved since the new manager had taken up post. All of the staff we spoke with said the manager was approachable and they felt they could raise any concerns with them.
We saw that team meetings were taking place regularly, the last one had taken place in November 2018 and we viewed the minutes of these, as well as the previous months.
The service also regularly gathered and analysed feedback from people living there, the staff, and relatives. We saw that no issues had been raised in the last feedback report.
The service worked well with the local hospitals to support people to safely transition into Byron Court.
There were policies and procedures in place for staff to follow, the staff were aware of these and their roles with regards to these polices.
We had the opportunity to discuss lessons learnt with the manager who gave us an example of how they had tried to promote a healthier team dynamic within the home.
The manager was aware of their roles and responsibilities and had reported all notifiable incidents to the Care Quality Commission as required. The ratings were clearly displayed in the communal area from the last inspection and on the registered providers webpage.