29 March 2023
During an inspection looking at part of 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.