Archived: Byron Lodge Care Home

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found staff were busy but had time to meet people's needs in a calm and caring way.

The rotas confirmed additional nurses had been recruited since our last visit which meant there were sufficient qualified staff to ensure two nurses worked throughout the day and one nurse worked during the night.

Is the service caring?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Four out of the five care plans we saw had risk assessments which stated the identified risk and how to minimise the risk.

We observed staff serving breakfast on one unit and found they interacted well with people and offered choices.

Is the service well led?

We saw that audits were completed in areas such as care records, dignity, environment, and medication and infection control. Any areas identified for action were addressed. We also saw the provider's compliance manager had completed recent audits and had produced an action plan for the home to address.

Below is a summary of what we found. The summary is based on our observations during the inspection on Shakespeare and Ruskin units (nursing) and Wordsworth and Browning units (residential). We spoke with five people using the service, six relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was not always planned and delivered in a way that ensured people's safety and welfare. Each person's care plan outlined the areas where they needed support but gave little or no instructions of how to support the person. There were risk assessments in place for people, which identified areas of risk associated with their care. However they did not state how risks could be minimised.

There were not always enough qualified, skilled and experienced staff to meet people's needs. We observed staff and some appeared to be rushed, therefore not able to spend the time required to complete tasks at the pace of the person who used the service.

Is the service effective?

We saw that care files contained a care plan regarding capacity and consent. This included decisions about people's care. Where people lacked capacity the care plans mainly indicated what to do to ensure consistency of care.

We saw that some people required food and fluid intake to be recorded. This was not consistently completed and we found gaps where food had not been recorded as eaten or offered. Food charts were not stored in a methodical order. This meant that not all food charts we asked to see could be found.

Is the service caring?

A large proportion of people living on the nursing units, were cared for in bed. Staff interacted with these people to provide personal care, but we did not see any social interaction with these people. This meant that they were left alone for long periods of time with not much to occupy them.

On the day of the inspection an activity coordinator was conducting a game of bingo in the entrance area. There was a hairdresser at the home on the day. Apart from this we saw very little social interaction, especially for people who were cared for in their bedrooms.

Is the service responsive?

We spent a period of time in the afternoon sat in the lounge area on Ruskin unit. We saw people were sat for periods of up to fifteen minutes without staff being present. We spoke with staff about what we had observed and they told us that meeting the needs of people who were cared for in bed took all of their time, leaving very little time to spend with people in the lounge area.

We saw that care plans were reviewed regularly but changes were not made to care plans to ensure people's needs were met.

Is the service well-led?

The people we spoke with felt they could raise concerns with the manager, but they were not sure that action was taken.

We saw that audits had been completed but where actions had been identified we found no record of what had been done to resolve the identified concern.

The system of assessing and monitoring the quality of service provision at Byron Lodge was inadequate. Whilst the audits and checks had identified areas in which improvements were required, actions had not been taken to make and sustain improvements to protect people and this could put them at risk of harm.

We asked the registered manager if any audits were completed around meals and nutrition. The registered manager said that there was a dining experience audit, but this had not been completed for a while and the last one could not be located.

On 21 January 2014 we served a fixed penalty notice to Mimosa Healthcare for failing to have a registered manager in place at Byron Lodge. A fine of '4,000 was paid. The organisations have since registered the manager.

We inspected the service on 11 July 2013 and found the provider to be compliant.

People expressed their views and were involved in making decisions about their care and treatment.

Peoples’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People felt that staff offered the support required and gave them time to be independent. One person said, “The staff are very helpful, I am happy here.” Another person’s relative said, “We are kept well informed.”

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

People were protected from the risk of infection because appropriate guidance had been followed. People we spoke with felt the home was kept clean and this had improved over recent weeks.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

We found there was an effective complaints system in place. People knew how to complain and felt their concern would be resolved.

Our inspection of 15 April 2013 found that the provider had employed a manager who had been in post for twelve weeks. This person is not yet registered as manager with the Care Quality Commission, therefore is referred to in this report as the acting manager.

We found that people who used the service were not involved in making decisions about their care and treatment.

We observed people who used the service and found that some people’s needs were not being attended to. We saw that some concerns regarding people’s care and welfare were not being addressed.

We found concerns around cleanliness and infection control. There were many areas of the home which were not maintained, not kept clean and parts which required redecoration.

We saw that medication was clearly recorded and people were receiving medication as prescribed.

We found that people's needs were identified in care plans. However, they were lacking in detail and some recordings were not easy to follow. We observed people who used the service and found that some people's needs were not attended to as required. We also observed some good staff interactions where staff offered choice to people and were able to communicate appropriately.

We found concerns around cleanliness and infection control. There were areas of the home which were not maintained, not kept clean and parts which required redecoration.

We saw that medication was not always clearly recorded and people did not always receive medication as prescribed. We raised these issues with the management team on the day of our inspection and they began to address concerns.

We found on the day of our visit that there were enough staff on duty to meet people's needs.