Byron Lodge Care Home Ltd

Updated 7 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Byron Lodge Care Home Ltd is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Byron Lodge Care Home Ltd is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had carried out a quality assurance visit.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service about their experience of the care provided. We spoke with 2 people's relatives and 1 person’s friend. We observed staff interactions with people and their care and support in communal areas. We spoke with 13 members of staff, including kitchen staff, care staff, activities staff, senior care staff, nurses, the deputy manager, the registered manager, the regional manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 9 people's care records and multiple medicines records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 7 June 2023

About the service

Byron Lodge Care Home Ltd is a residential care home providing accommodation for persons who require nursing or personal care to up to 28 people. The service provides support to older people, some of whom lived with dementia, and 16 people were cared for in bed. At the time of our inspection there were 25 people using the service, 1 of whom was in hospital on the first day of the inspection, and 2 people were in hospital on the second day of the inspection.

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

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed. Some areas of the service were not clean. We were not always assured that the provider was using personal protective equipment effectively and safely. Meals and drinks were not always prepared to meet people's preferences and dietary needs.

The service was not always well led. Records were not always robust and accurate. The provider had failed to identify issues relating to risk assessments, medicines management, infection control, mental capacity and person-centred planning. Their quality monitoring processes had not identified issues with records that we found on inspection.

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 this practice.

People's care was not always planned in a way that centred on the individual and met the needs and wishes of people.

Most staff had received training relevant to their roles, however some staff required training in catheter care and fire drills to make sure they could meet people’s needs effectively.

Despite the feedback above, people and relatives told us staff were kind, caring and friendly. Comments included, “Care is good and atmosphere is good and activities are happening”; “They’re all so happy here. They’re really lovely. They really look after you” and “I felt at home straight away. I chose to stay here after my assessment from the hospital.”

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. Assessments of staffing levels were undertaken by the registered manager and regional manager. There were enough staff deployed to provide safe care. However, some people told us they sometimes had to wait for care.

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.

People were supported to access support from healthcare professionals. Most people told us they enjoyed their food. The provider had systems and processes in place to manage complaints.

Activities took place to stimulate people, this included some 1:1 activities for those cared for in bed. Activities did not meet everyone’s needs, we received mixed feedback from people.

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 01 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The directors for the provider had changed in December 2022, because the previous provider had sold their business.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led. As we found a breach of regulation in relation to mental capacity and DoLS and a breach in regulation in relation to planning people’s care we extended the inspection to include all domains.

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.

Enforcement

We have identified breaches in relation to risk management, medicines management, infection control, managing nutrition and hydration, mental capacity and DoLS, care planning and effective quality assurance process at this inspection.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.